Korean Circ J.  2011 Apr;41(4):184-190. 10.4070/kcj.2011.41.4.184.

Decreased Glomerular Filtration Rate is an Independent Predictor of In-Hospital Mortality in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

• Kim JY
• Jeong MH
• Ahn YK
• Moon JH
• Chae SC
• Hur SH
• Hong TJ
• Kim YJ
• Seong IW
• Chae IH
• Cho MC
• Kim CJ
• Jang YS
• Yoon J
• Seung KB
• Park SJ
• Other Korea Acute Myocardial Infarction Registry Investigators

• KMID: 2028942
• DOI: http://doi.org/10.4070/kcj.2011.41.4.184

Abstract

BACKGROUND AND OBJECTIVES
Patients with renal dysfunction (RD) experience worse prognosis after myocardial infarction (MI). The aim of the present study was to investigate the impact of admission estimated glomerular filtration rate (eGFR) on clinical outcomes of patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation MI (STEMI).
SUBJECTS AND METHODS
We retrospectively evaluated 4,542 eligible patients from the Korea Acute Myocardial Infarction Registry (KAMIR). Patients were divided into three groups according to eGFR (mL/min/1.73 m2): normal renal function (RF) group (eGFR > or =60, n=3,515), moderate RD group (eGFR between 30 to 59, n=894) and severe RD group (eGFR <30, n=133). Baseline characteristics, angiographic and procedural results, and in-hospital outcomes between the three groups were compared.
RESULTS
Age, gender, Killip class > or =3, hypertension, diabetes, congestive heart failure, peak creatine kinase-MB, high sensitivity C-reactive protein, B-type natriuretic peptide, left ventricle ejection fraction, multivessel disease, infarct-related artery and rate of successful PCI were significantly different between the 3 groups (p<0.05). With decline in RF, in-hospital complications developed with an increasing frequency (14.1% vs. 31.8% vs. 45.5%, p<0.0001). In-hospital mortality rate was significantly higher in the moderate and severe RD groups as compared to the normal RF group (2.3% vs. 13.9% vs. 25.6%, p<0.0001). Using multivariate logistic regression analysis, adjusted odds ratio for in-hospital mortality was 2.67 {95% confidence interval (CI) 1.44-4.93, p=0.002} in the moderate RD group, and 4.09 (95% CI 1.48-11.28, p=0.006) in the severe RD group as compared to the normal RF group.
CONCLUSION
Decreased admission eGFR was associated with worse clinical courses and it was an independent predictor of in-hospital mortality in STEMI patients undergoing primary PCI.

Keyword

Glomerular filtration rate; Acute myocardial infarction; Mortality; Percutaneous coronary intervention

MeSH Terms

Arteries
C-Reactive Protein
Creatine
Glomerular Filtration Rate
Heart Failure
Heart Ventricles
Hospital Mortality
Humans
Hypertension
Korea
Logistic Models
Myocardial Infarction
Natriuretic Peptide, Brain
Odds Ratio
Percutaneous Coronary Intervention
Prognosis
Retrospective Studies
C-Reactive Protein
Creatine
Natriuretic Peptide, Brain

Figure

• 

  Fig. 1 Study flow chart. STEMI: ST-segment elevation myocardial infarction, KAMIR: Korea Acute Myocardial Infarction Registry, PCI: percutaneous coronary intervention.

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  Fig. 2 Incidence of in-hospital mortality according to the levels of estimated glomerular filtration rate.

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