Key result
Lower eGFR is linked to a ~3.6-fold higher CV death risk in post-MI acute heart failure.
Why the study?
The relationships between renal function and clinical course and outcomes of ST-segment elevation MI complicated by acute heart failure in patients with preserved LV systolic function were not well characterized.
Does renal dysfunction predict re-infarction and cardiovascular death in patients with STEMI and preserved LVEF?
Cohort (n=491)
No
Does renal dysfunction predict re-infarction and cardiovascular death in patients with STEMI and preserved LVEF?
Hazard Ratio: 3.61 (95% CI 1.09–11.99)
p-value: p=<0.05
Renal dysfunction is a strong independent predictor of re-infarction and cardiovascular death in patients with STEMI and preserved LVEF, regardless of the presence of acute heart failure.
eGFR <70 ml/min was associated with re-infarction and CV death in acute HF; hypothesis-generating for risk stratification in STEMI with preserved LVEF.
Aiming to assess the relationships between renal function and ST-segment elevation myocardial infarction (MI) clinical course and remote outcomes in patients with preserved systolic left ventricular (LV) function (LV ejection fraction > 40%) estimated glomerular filtration rates (eGFR) were evaluated on 1st and 3rd -10th MI day (n = 491). On 3rd-10th day of MI in patients with acute heart failure (HF) symptoms on admission day (1st group, n = 153) eGFR < 70 ml/min x per body surface unit was independent marker of re-infarction (Hazzard Ratio (HR) with 95% confidence intervals (95% CI) = 4,08 [1,72 -11,73], P < 0,01) and cardiovascular death (CVD) (HR [95% CI] = 3,61 [1,09 - 11,99], P = <0,05) during three years of follow-up. In patient without acute HF (2nd group, n = 338) eGFR < 68 ml/min was predictive of CVD within three years post-MI (HR [95% CI] = 7,13 [2,06 - 24,74], P = 0,002). eGFR did not correlate with myocardial damage markers. In the 1st group eGFR on the 3rd MI day was negatively correlated with tumor-necrosis factor alpha (TNF-alpha) and vascular endothelial growth factor levels. There were no correlation between systemic inflammation activation with eGFR in 2nd study group indicating different mechanisms of renal dysfucntion in patients with and without acute HF and preserved LV function.
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Parkhomenko et al. (2013) conducted a cohort in Acute myocardial infarction with ST-segment elevation and preserved systolic function (n=491). Renal dysfunction (eGFR < 70 ml/min/1.73m2) vs. Preserved renal function (eGFR ≥ 70 ml/min/1.73m2) was evaluated on Cardiovascular death at 3 years (in patients with acute heart failure) (HR 3.61, 95% CI 1.09-11.99, p=<0.05). In patients with myocardial infarction, preserved systolic function, and acute heart failure, an eGFR < 70 ml/min was associated with a significantly increased risk of cardiovascular death (HR 3.61) at 3 years.
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