Severe renal impairment in patients with acute myocardial infarction undergoing percutaneous coronary intervention significantly increased the risk of cardiovascular death (HR 4.87).
Cohort (n=611)
No
Does renal impairment worsen clinical outcomes and cardiac remodeling in patients with AMI undergoing PCI?
In AMI patients undergoing PCI, worse renal function is associated with less use of guideline-directed medical therapy, worse left ventricular function, and increased cardiovascular mortality and adverse outcomes.
Effect estimate: HR 4.87 (95% CI 1.24-19.02)
p-value: p=0.02
How renal function influences post-acute myocardial infarction (AMI) cardiac remodeling and outcomes remains unclear. This study evaluated the impact of levels of renal impairment on drug therapy, echocardiographic parameters, and outcomes in patients with AMI undergoing percutaneous coronary intervention (PCI). A total of 611 patients diagnosed with AMI underwent successful PCI, and two echocardiographic examinations were performed within 1 year after AMI. Patients were categorized according to Group 1: severely impaired estimated glomerular filtration rate (eGFR)<30, Group 2: mildly impaired 30≤eGFR<60, Group 3: potentially at risk 60≤eGFR<90 and normal eGFR≥90 ml/min/1.73 m2. During the 5-year follow-up period, the primary endpoints were cardiovascular mortality and outcomes. Patients with worse renal function (eGFR<30) were older and had a higher prevalence of hypertension and diabetes, but relatively few were smokers or had hyperlipidemia. Despite more patients with lesions of the left anterior descending artery, those with worse renal function received suboptimal guideline-directed medical therapy (GDMT). Notably, patients with worse renal function presented with worse left ventricular function at baseline and subsequent follow-up. Kaplan-Meier analysis revealed increased cardiovascular death, development of heart failure, recurrent AMI and revascularization in patients with worse renal function. Notably, as focusing on patients with ST elevation MI, the similar findings were observed. In multivariable Cox regression, impaired renal function showed the most significant hazard ratio in cardiovascular death. Collectively, in AMI patients receiving PCI, outcome differences are renal function dependent. We found that patients with worse renal function received less GDMT and presented with worse cardiovascular outcomes. These patients require more attention.
Chiang et al. (Fri,) conducted a cohort in Acute myocardial infarction (AMI) (n=611). Severe renal impairment (eGFR < 30 ml/min/1.73m2) vs. Preserved renal function (eGFR ≥ 90 ml/min/1.73m2) was evaluated on Cardiovascular mortality (HR 4.87, 95% CI 1.24-19.02, p=0.02). Severe renal impairment in patients with acute myocardial infarction undergoing percutaneous coronary intervention significantly increased the risk of cardiovascular death (HR 4.87).