Abstract
Objectiveto explore the impact of admission serum creatinine concentration on the in-hospital mortality and its interaction with age and gender in patients with acute ST-segment elevation myocardial infarction (STEMI) in China.Methods1424 acute STEMI patients were enrolled in the study. Anthropometric and laboratory measurements were collected from every patient. A Cox proportional hazards regression model was used to determine the relationships between the admission serum creatinine level (Cr level), age, sex and the in-hospital mortality. A crossover analysis and a stratified analysis were used to determine the combined impact of Cr levels with age and gender.ResultsFemale (HR 1.687, 95%CI 1.051∼2.708), elevated Cr level (HR 5.922, 95%CI 3.780∼9,279) and old age (1.692, 95%CI 1.402∼2.403) were associated with a high risk of death respectively. After adjusting for other confounders, the renal dysfunction was still independently associated with a higher risk of death (HR 2.48, 95% CI 1.32∼4.63), while female gender (HR 1.19, 95%CI 0.62∼2.29) and old age (HR 1.77, 95%CI 0.92∼3.37) was not. In addition, crossover analysis revealed synergistic effects between elevated Cr level and female gender (SI = 3.01, SIM = 2.10, AP = 0.55). Stratified analysis showed that the impact of renal dysfunction on in-hospital mortality was more pronounced in patients <60 years old (odds ratios 11.10, 95% CI 3.72 to 33.14) compared with patients 60 to 74 years old (odds ratios 5.18, 95% CI 2.48∼10.83) and patients ≥75years old (odds ratios 3.99, 95% CI 1.89 to 8.42).ConclusionSerum Cr concentration on admission was a strong predictor for in-hospital mortality among Chinese acute STEMI patients especially in the young and the female.
Highlights
ST-segment elevation myocardial infarction (STEMI) is a clinical syndrome defined by characteristic symptoms of myocardial ischemia in association with persistent electrocardiographic (ECG) ST elevation and subsequent release of biomarkers of myocardial necrosis [1]
After adjusting for other confounders, including smoking and drinking status, diabetes, CK levels and stent use, the renal dysfunction was still strongly associated with a higher risk of death (HR 2.48, 95% confidence intervals (CI) 1.32,4.63), while female gender(HR 1.19,95%CI 0.62,2.29) and old age (HR 1.77, 95%CI 0.92,3.37) not (Table 3)
Regarding the conventional risks of the male or young with normal Cr level as being 1.0, the Hazard ratios (HR) estimating the effects of joint exposure to elevated Cr level and female gender or old age were significantly higher than the HRs estimating the effects of each factor in the absence of the other
Summary
ST-segment elevation myocardial infarction (STEMI) is a clinical syndrome defined by characteristic symptoms of myocardial ischemia in association with persistent electrocardiographic (ECG) ST elevation and subsequent release of biomarkers of myocardial necrosis [1]. Differing from USA, where the incidence of acute STEMI and rates of death attributable to CVD have declined [3,4], cardiovascular diseases are rising as the primary cause of death and disability in China in decades [5,6]. Patients with acute STEMI face higher in-hospital mortality for many factors. Renal dysfunction has been established as one of the most important predictors of in-hospital and long-term mortality in the acute STEMI patients [7,8], age as another significant predictor of adverse outcomes in this group, is related with the renal function [9,10,11], It has been reported that females with acute myocardial infarction (AMI) have a higher risk of adverse events [12,13]. The relationship between the admission serum creatinine concentration (mmol/l) and the prognosis of acute STEMI patients has not been well characterized in China and few data are available concerning its interaction
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