Abstract
BackgroundRenal dysfunction is one of the major causes of in-hospital mortality in STEMI patients. In this study, we evaluated the combined predictive value of eGFR by CKD-EPI equation and shock index for in-hospital mortality and other adverse clinical outcomes in Egyptian patients with STEMI.ResultsA total of 450 STEMI patients were divided into 2 groups according to their eGFR with a cutoff value of 60 ml/min/1.73 m2 and compared as regards mortality, major bleeding, reinfarction, development of heart failure, stroke, and atrial fibrillation during the period of admission. Univariate analysis was performed to define significant factors that affected mortality; then, significant factors were subjected to a multivariate logistic regression.Patients with eGFR < 60 ml/min/1.73 m2 had higher rates of mortality (P < 0.0005) and atrial fibrillation (P = .006) during the hospital admission. A multivariate logistic regression model showed the predictors of mortality were factors SI (OR = 28.56, 95% CI 8–101.97, P < 0.0001), cardiac troponin (OR = 2.89, 95% CI 1.08–7.77, P = 0.03), age (OR = 1.07, 95% CI 1.02–1.2, P = 0.002), and eGFR (OR = 0.98, 95% CI 0.96–0.99, P = 0.04).ConclusionsEstimated GFR < 60 ml/min/1.73 m2 in STEMI patients is associated with higher rate of mortality. Estimated GFR, age, shock index, and cardiac troponin were the most significant predictors of mortality in STEMI patients
Highlights
Renal dysfunction is one of the major causes of in-hospital mortality in ST elevation myocardial infarction (STEMI) patients
Patients who fulfilled the following criteria were included: (a) diagnosis of STEMI according to ACCF/ AHA Guideline for the Management of STEMI where 290 patients received thrombolytic therapy,74 treated by primary percutaneous coronary intervention (PCI), 32 had PCI after failed thrombolytic, and 54 patients did not receive thrombolytic therapy or PCI due to late presentation or presence of a contraindication [11] and (b) aged > 18 years and the data were collected from the electronic medical record of specialized medical hospital of cardiovascular department
Data collection All patients were retrospectively analyzed depending on the following: (a) general data, e.g., age, gender, body mass index (BMI), smoking status, duration of hospital admission, and history of other medical disorders; (b) diagnosis on admission, e.g., cardiac condition, cardiac complications, diabetes mellitus (DM), dyslipidemia, and hypertension (HTN); (c) vital data on admission, e.g., systolic blood pressure (SBP), diastolic blood pressure (DBP), and basal heart rate (HR); and (d) biochemical data on admission to avoid the effect of treatment on the results including serum creatinine, random blood sugar, creatine kinase (CK-MB), qualitative troponin, uric acid, and lipid profile. Estimated glomerular filtration ratio (eGFR) was calculated at the time of admission using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2009 creatinine equation [6]
Summary
Renal dysfunction is one of the major causes of in-hospital mortality in STEMI patients. We evaluated the combined predictive value of eGFR by CKD-EPI equation and shock index for in-hospital mortality and other adverse clinical outcomes in Egyptian patients with STEMI. Disease Epidemiology Collaboration (CKD-EPI) equation has been validated as a more simple and accurate marker of renal function [6]. Shock index (SI) is a simple index that means the ratio of heart rate (HR) to systolic blood pressure (SBP). This index has shown a good predictive value for hospital mortality in many critical situations, including trauma [7], pulmonary embolism [8], aortic dissection [9], and STEMI [10]
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