Key result
Admission renal impairment in STEMI predicts ~338% higher 1-year death or heart failure risk.
Why the study?
The impact of impaired renal function on myocardial tissue reperfusion and long-term outcomes in STEMI patients treated with primary PCI was unclear.
Does impaired renal function increase the risk of failed myocardial tissue reperfusion and worse long-term outcomes in STEMI patients treated with primary PCI?
Cohort (n=200)
No
Does impaired renal function increase the risk of failed myocardial tissue reperfusion and worse long-term outcomes in STEMI patients treated with primary PCI?
Odds Ratio: 4.38 (95% CI 1.34–14.28)
Absolute Event Rate: 56% vs 16%
p-value: p=0.014
Impaired renal function at admission in STEMI patients undergoing primary PCI is associated with a higher risk of failed myocardial tissue reperfusion and subsequent 1-year mortality or heart failure.
Aim: The aim was to assess the impact of impaired renal function on myocardial tissue reperfusion in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI).Material and methods: Impaired renal function was diagnosed at admission based on abnormal serum creatinine level (> 106 μmol/l).Patients with anterior STEMI and maximal single-lead ST-elevation (maxSTPost) exceeding 2 mm up to 90 min post-procedure, as well as patients with inferior STEMI and maxSTPost > 1 mm, were considered to have failed tissue reperfusion.The incidence of death or heart failure (NYHA class > 2) was prospectively assessed over a subsequent 12-month period.Results: Primary PCI and maxSTPost measurements were performed in 200 out of 208 consecutive patients (63.0 ±12.1 years, 67.5% males) treated between October 2007 and September 2008.Patients with impaired renal function (12.5%) died or developed heart failure more often when compared to the remaining individuals (56.0% vs. 16.0%,p < 0.001, respectively).Patients with failed reperfusion (15.5%) had higher incidence of one-year mortality and heart failure (35.5% vs. 18.3%, p = 0.032, respectively).Failed tissue reperfusion was 2.5 times more frequent among patients with impaired renal function, despite a relatively high rate of final TIMI 3 flow as compared to the remaining subjects (32.0% vs. 13.1%,p = 0.022 and 84.0% vs. 92.6%,p = 0.239, respectively).Impaired renal function and failed reperfusion were independent predictors of death or heart failure (odds ratio (OR) = 4.38, 95% confidence interval (CI) 1.34-14.28,p = 0.014, and OR = 3.34, 95% CI 1.12-9.88,p = 0.029, respectively).Impaired renal function was a risk factor for failed tissue reperfusion (OR = 2.98, 95% CI 1.03-8.68,p = 0.044).Conclusions: Impaired renal function in patients with STEMI treated with primary PCI is related to the risk for failed myocardial tissue reperfusion, leading in consequence to higher one-year mortality and heart failure.
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Karwowski et al. (2012) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=200). Impaired renal function (serum creatinine > 106 μmol/l) vs. Normal renal function was evaluated on Death or heart failure symptoms during the first year (OR 4.38, 95% CI 1.34-14.28, p=0.014). Impaired renal function at admission in STEMI patients treated with primary PCI independently predicted a significantly increased risk of death or heart failure at 1 year (OR 4.38).
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