Functional state of kidneys in patients with acute myocardial infarction

Abstract

The aim. To assess the functional state of the kidneys in patients with acute myocardial infarction and to determine the effect of reduced glomerular filtration rate on the course of the disease.Material and methods. A retrospective analysis of 410 medical records of patients who were treated for STEMI in the department for patients with myocardial infarction of the Vinnytsia Regional Clinical Medical and Diagnostic Center for Cardiovascular Pathology in 2019 was conducted. All patients were hospitalized within 12 hours of the onset of pain, all patients underwent urgent revascularization of the infarct-related artery. The average age of the examined was 64.8±0.4 years. There were 263 men (64.1%), average age 60.8±0.2 years and 147 women (35.9%), average age 68.8±0.5 years. Results. It was found that the average level of creatinine was 101.5±2.2 μmol/l, no significant difference between men and women was found. The level of GFR was 64.8±1.1 ml/min/1.73m2 and was significantly lower among women than men (p<0.001). GFR ≥90 ml/min/1.73m2 was diagnosed in 31 patients (7.5%), no significant difference between men and women was established. GFR 60-89 ml/min/1.73m2 was found in 206 people (50.2%), significantly more often among men than among women (p<0.001). GFR of 30-59 ml/min/1.73m2 was established in 160 patients (39.1%), significantly more often among women than men (p<0.001). 11 people (2.7%) had GFR within 15-29 ml/min/1.73m2, no difference was noted between men and women. Significantly more patients with Killip III were in the II group (p<0.001), and with Killip IV (p<0.001). Among the medical records of the deceased that we analyzed were 28 patients (6.8%). A significantly larger number of patients who died were among patients with GFR less than 60 ml/min/1.73m2, namely 24 people (13.8%), p<0.001.Conclusions. It was established that in STEMI patients who underwent urgent revascularization, the average level of GFR was 64.8±1.1 ml/min/1.73m2. 173 people (42.2%) had a decrease in GFR of less than 60 ml/min/1.73m2. A decrease in GFR was significantly more often diagnosed in women than in men (p≤0.001), women were significantly older than men (p≤0.001). In the group of patients with GFR less than 60 ml/min/1.73m2, there were significantly more patients with hypertension for more than 10 years (p≤0.001) and diabetes for more than 10 years (p=0.067), there were significantly more people with peripheral artery disease (p=0.017). In the group of patients with STEMI and GFR less than 60 ml/min/1.73m2, significantly more HF of high gradations (Killip III-IV) were detected - in 36 people (20.7%). In-hospital mortality was significantly higher in patients with reduced GFR, 2% and 13.8%, respectively, p<0.001.