Association of creatinine and creatinine clearance on presentation in acute myocardial infarction with subsequent mortality
Key result
Severely impaired creatinine clearance is linked to ~281% higher 30-day mortality in fibrinolysis-treated STEMI.
- OR 3.81
- 95% CI 2.57-5.65
- P<0.001
Why the study?
Impaired renal function is known to be associated with poorer outcomes in unstable angina, non-STEMI, and after PCI, but its impact on clinical outcomes in STEMI patients treated with fibrinolysis was unclear.
Population
Patients with STEMI from TIMI-10, TIMI-14, and InTIME-II trials
Comparison
Normal vs mildly and severely impaired creatinine and creatinine clearance on presentation
Design
Cohort analysis of clinical trial data
Follow-up
30 days
Authors
Discussion
Loading...
Member takes
Implication
Pooled clinical trial analysis reveals increased 30-day mortality in STEMI patients with impaired renal function, indicating renal markers independently predict risk.
Key Points
- To determine whether baseline renal dysfunction, measured by creatinine and creatinine clearance, correlates with increased 30-day mortality among patients with STEMI undergoing fibrinolysis.
- Analyzed pooled patient data from three clinical trials: TIMI-10, TIMI-14, and InTIME-II.
- Stratified patients by presentation serum creatinine levels (Cr ≤1.2, >1.2 to 2.0, and >2.0 mg/dl) and creatinine clearance (CrCl ≥90, 60 to <90, 30 to <60, and <30 ml/min) within TIMI risk score categories.
- Assessed independent 30-day mortality using multivariable logistic regression adjusted for known clinical correlates and TIMI risk score.
- Across all TIMI risk score categories, 30-day mortality increased in a stepwise fashion with worsening creatinine (p < 0.001) and declining creatinine clearance (p < 0.001).
- Multivariable adjustment confirmed higher mortality for mild creatinine elevation (OR 1.52, 95% CI 1.30–1.77, p < 0.001) and severe elevation (OR 3.73, 95% CI 2.55–5.45, p < 0.001).
- Impaired creatinine clearance independently increased mortality across mild (OR 1.38, 95% CI 1.10–1.73, p = 0.006), moderate (OR 2.06, 95% CI 1.59–2.66, p < 0.001), and severe groups (OR 3.81, 95% CI 2.57–5.65, p < 0.001).
Study Design
Type
Cohort
Multicenter
Yes
PICO
P
Population
Patients with ST-segment elevation myocardial infarction treated with fibrinolysis, drawn from the TIMI-10, TIMI-14, and InTIME-II trials, assessed for 30-day mortality.
E
Exposure / Comparator
Impaired renal function vs Normal renal function
O
Primary Outcome
30-day mortality — OR 3.81 (2.57-5.65), p=<0.001
Main Result
Odds Ratio: 3.81 (95% CI 2.57–5.65)
p-value: p=<0.001
Cite This Study
Gibson et al. (2003) conducted a cohort in ST-segment elevation myocardial infarction (STEMI). Impaired renal function vs. Normal renal function was evaluated on 30-day mortality (OR 3.81, 95% CI 2.57-5.65, p=<0.001). In patients with STEMI treated with fibrinolysis, severely impaired creatinine clearance on presentation was independently associated with increased 30-day mortality (OR 3.81; 95% CI 2.57-5.65; p<0.001).