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Baseline renal insufficiency in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction is a powerful independent predictor of increased short- and long-term mortality, bleeding complications, and restenosis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

November 25, 2003Open Access

Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

Structured PICO

Does baseline renal insufficiency increase mortality and complications in AMI patients undergoing primary PCI?

Population

2,082 AMI patients without shock presenting within 12 hours of symptom onset undergoing primary PCI

Intervention

Baseline renal insufficiency (calculated Cockroft-Gault creatinine clearance <=60 mL/min)

Comparator

No baseline renal insufficiency

Outcome

Mortality at 30 days and 1 yearhard clinical

Baseline renal insufficiency in AMI patients undergoing primary PCI is a strong independent predictor of short- and long-term mortality, as well as bleeding and restenosis.

Abstract

BACKGROUND: The prognostic importance of renal insufficiency (RI) in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) has not been well characterized. METHODS AND RESULTS: PCI was performed in 2082 AMI patients without shock presenting within 12 hours of symptom onset in a prospective, multicenter randomized trial. RI was defined as a calculated (Cockroft-Gault) creatinine clearance (CrCl) or =70%; 20.6% versus 11.8%, P=0.024) and infarct artery reocclusion (14.7% versus 7.3%, P=0.02). CONCLUSIONS: Baseline RI in patients with AMI undergoing primary PCI is associated with a markedly increased risk of mortality, as well as bleeding and restenosis. Novel approaches are needed to improve the otherwise poor prognosis of patients with RI and AMI.

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