The Impact of Renal Insufficiency upon Admission on the Clinical Outcome of Patients with Acute ST-elevation Myocardial Infarction undergoing Primary Percutaneous Coronary Intervention
Background: Coronary artery disease is common in patients with renal insufficiency. In acute coronary syndrome, impaired renal function is present in approximately 30-40% of patients and is associated with worse prognosis. Local data regarding the risks and benefits for those patients suffering from acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) is scarce. We evaluated the clinical outcomes of patients suffering from STEMI with and without renal insufficiency upon admission who underwent PPCI.
Methods: From 1st January 2009 to 30th September 2017, all patients with STEMI treated with PPCI were identified. The primary composite endpoint was defined as a composite outcome of all-cause mortality and MACE (cardiovascular mortality, non-fatal MI, stroke and target vessel revascularization). The secondary endpoints were the individual components of the primary composite endpoint. Estimated GFR was calculated by the CKD-EPI equation. Renal insufficiency was defined as eGFR <60mL/min/1.73m2.
Results: The cohort consisted of 450 patients of whom 191 patients (42.4%) had renal insufficiency. Compared with patients with normal renal function, they were older, more often female and more likely to have other co-morbidities. After taking potential confounders into account in the multivariate analysis, patients with renal insufficiency had a higher risk of primary composite outcome during long-term follow up with an adjusted hazard ratio of 1.48 (95% CI 1.02-2.15, p=0.038). They also had significantly higher risk of all-cause mortality, MACE and cardiovascular death with adjusted hazard ratios of 1.66, 1.90 and 2.01 respectively (p
Conclusion: In an unselected cohort of STEMI patients treated with PPCI, renal insufficiency was associated with adverse clinical outcome when compared to STEMI patients without renal insufficiency.
Wai Lun KWONG, Kwok Ho YAU, Eugene SIN, Kwok Keung CHAN, The Impact of Renal Insufficiency upon Admission on the Clinical Outcome of Patients with Acute ST-elevation Myocardial Infarction undergoing Primary Percutaneous Coronary Intervention Journal of the Hong Kong College of Cardiology 2023;29(5) https://doi.org/10.55503/2790-6744.1486