Key result
Renal impairment predicts ~286% greater in-hospital mortality in STEMI with cardiogenic shock or cardiac arrest.
Why the study?
The association of renal impairment with mortality in STEMI complicated by cardiogenic shock and/or cardiac arrest was not well characterized.
Does renal impairment increase in-hospital and 1-year mortality in patients with STEMI complicated by cardiogenic shock or cardiac arrest?
Cohort (n=13,463)
Yes
Does renal impairment increase in-hospital and 1-year mortality in patients with STEMI complicated by cardiogenic shock or cardiac arrest?
Odds Ratio: 3.86 (95% CI 2.6–5.8)
Absolute Event Rate: 43% vs 15%
p-value: p=<0.001
Renal impairment is a strong independent predictor of mortality in STEMI patients, with a disproportionately greater impact on those presenting with cardiogenic shock or cardiac arrest.
RI identifies STEMI-CS/CA patients at markedly higher mortality risk; leaves open whether RI is causal or a modifiable target.
OBJECTIVES: We sought to study the association of renal impairment (RI) with mortality in ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock and/or cardiac arrest (CS/CA). METHODS: ) were identified from the Midwest STEMI consortium, a prospective registry of four large regional programs comprising consecutive patients over 17 years. Primary outcome was in-hospital and 1-year mortality stratified by RI status and presence of CS/CA among patients with STEMI referred for coronary angiography. RESULTS: In a cohort of 13,463 STEMI patients, 13% (n = 1754) had CS/CA, 30% (n = 4085) had RI. Overall, in-hospital mortality was 5% (12% RI vs. 2% no-RI, p < 0.001) and 1-year mortality 9% (21% RI vs. 4% no-RI, p < 0.001). Among uncomplicated STEMI, in-hospital mortality was 2% (4% RI vs. 1% no-RI, p < 0.001) and 1-year mortality 6% (13% RI vs. 3% no-RI, p < 0.001). In STEMI with CS/CA, in-hospital mortality was 29% (43% RI vs. 15% no-RI, p < 0.001) and 1-year mortality 33% (50% RI vs. 16% no-RI, p < 0.001). Using Cox proportional hazards, RI was an independent predictor of in-hospital mortality in STEMI with CS/CA (odds ratio [OR]: 3.86; confidence interval [CI]: 2.6, 5.8). CONCLUSIONS: The association of RI with in-hospital and 1-year mortality is disproportionately greater in those with CS/CA compared to uncomplicated STEMI presentations. Factors predisposing RI patients to higher risk STEMI presentations and pathways to promote earlier recognition in the chain of survival need further investigation.
No takes yet. Share an insight, caveat, or question.
Shroff et al. (2023) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=13,463). Renal impairment vs. No renal impairment was evaluated on In-hospital mortality in STEMI with cardiogenic shock/cardiac arrest (OR 3.86, 95% CI 2.6-5.8, p=<0.001). Renal impairment was an independent predictor of in-hospital mortality in patients with STEMI complicated by cardiogenic shock or cardiac arrest (OR 3.86; 95% CI 2.6-5.8).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: