0189: Reperfusion strategy in renal dysfunction patients presenting with STEMI

Abstract

Patients with renal insufficiency experience worse prognosis after STEMI. Aim of the study to compare primary PCI (PPCI) and thrombolysis results as well as in-hospital mortality after successful reperfusion between patients with or without renal dysfunction (RD). From January 1995 to October 2014, 1588 patients admitted for STEMI were enrolled in our registry. Two reperfusion groups were identified: PPCI (315 patients) and thrombolysis (379 patients). We compared the group of RD patients (RD+) and normal renal function patients (RD). Our main endpoints were: (1) The success of reperfusion and (2) the in-hospital mortality. Ninety patients (13%) had RD, 50% of which underwent PPCI, and 50% received thrombolytics. In the PPCI group, although TIMI flow was similar before angioplasty (p=0.82), TIMI III flow restoration was significantly lower in the RD+ group (78.6% vs 91.8%, p=0.013). Suboptimal result was also higher in the RD+ group (13.6% vs 2.7%, p<0.001), but ST regression after TIMI III achievement was similar in the 2 groups (p=0.43) reflecting probably no microvascular damage. In the thrombolysis group, successful reperfusion was also significantly lower when RD exists (58% vs 74%, p=0.03), but RD was not an independent predictor of thrombolysis failure. RD was an independent mortality predictor either after PPCI or thrombolysis (respectively p=0.014, OR=4.39 and p=0.006, OR=4.93). After successful reperfusion, in-hospital mortality was higher among RD+ patients in the PPCI group (33.3% vs 4.3%, p<0.001), whereas it was similar after successful thrombolysis (p=0.42). In-hospital mortality was higher in RD+ patients when mechanically reper-fused (40% vs 18.2%, p=0.024), whereas no significant difference was found among RD- patients (p=0.75). RD reduces PPCI success. Although RD was an independent mortality predictor regardless of the reper-fusion strategy, prognosis was worse in RD group only after successful PPCI.