Key result
Mild renal impairment (eGFR 60-89 ml/min/1.73 m2) was a strong independent predictor of death compared with eGFR ≥90 ml/min/1.73 m2 in STEMI patients (HR 2.79; 95% CI 1.98-3.92; p<0.001).
Why the study?
The prognostic significance of mild renal impairment with an eGFR of 60-89 ml/min/1.73 m2 on survival after STEMI was unclear.
Does mild renal impairment (eGFR 60-89 ml/min/1.73 m2) predict mortality in patients with STEMI undergoing emergency catheterization?
Cohort (n=601)
No
Does mild renal impairment (eGFR 60-89 ml/min/1.73 m2) predict mortality in patients with STEMI undergoing emergency catheterization?
Hazard Ratio: 2.79 (95% CI 1.98–3.92)
p-value: p=<0.001
Mild chronic kidney disease (eGFR 60-89 ml/min/1.73 m2) is a strong independent predictor of short- and long-term mortality in STEMI patients undergoing primary PCI, suggesting a need to redefine clinically significant renal impairment thresholds.
OBJECTIVE: Moderate renal impairment (RI) with a glomerular filtration rate (GFR) <60 ml/min/1.73 m2 is known to predict survival. The authors investigated whether mild RI with an estimated GFR of 60-89 ml/min/1.73 m2 independently predicts survival in a contemporary population with ST segment elevation myocardial infarction (STEMI). DESIGN: This is a single-centre, observational, retrospective cohort study. Patients 601 patients with STEMI who underwent emergency catheter laboratory admission met the inclusion criteria for this study. METHODS: Estimated glomerular filtration rate (eGFR) was obtained by the Modified Diet in Renal Disease equation, and preprocedure renal function was subdivided into chronic kidney disease stages. Univariate and multivariate Cox regression analyses were performed to assess which of 17 patient or procedural variables were independent risk factors for death. RESULTS: Longitudinal data were collated for 576 patients (96.3%). Median follow-up time was 2.6 years. 30-day and long-term death rates were 5.7% and 12.5%, respectively. Following multivariable analysis, mild RI with an eGFR of 60-89 ml/min/1.73 m2 was a strong independent predictor of death, compared with an eGFR ≥90 ml/min/1.73 m2 (HR 2.79, 95% CI 1.98 to 3.92, p<0.001), and increasing chronic kidney disease stage was a strong predictor of death after both 30 days and long-term follow-up. An eGFR of 60-89 ml/min/1.73 m2 had a greater independent effect on short- and long-term mortality than the presence of diabetes mellitus (HR 2.0, 95% CI 1.2 to 3.33). CONCLUSION: Mild RI (eGFR=60-89 ml/min/1.73 m2) on admission is strongly predictive of short- and long-term mortality in patients with STEMI admitted to the catheter laboratory. A redefined threshold of clinically significant impairment is now required (GFR<90 ml/min/1.73 m2).
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Campbell et al. (2011) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=601). Mild renal impairment (eGFR 60-89 ml/min/1.73 m2) vs. eGFR ≥90 ml/min/1.73 m2 was evaluated on Death (HR 2.79, 95% CI 1.98 to 3.92, p=<0.001). Mild renal impairment (eGFR 60-89 ml/min/1.73 m2) was a strong independent predictor of death compared with eGFR ≥90 ml/min/1.73 m2 in STEMI patients (HR 2.79; 95% CI 1.98-3.92; p<0.001).
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