Abstract
BackgroundChronic kidney disease is associated with increased risk of mortality. We examined the impact of moderate and severe renal insufficiency (RI) on short- and long-term mortality among unselected patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).MethodsFrom January 1, 2002 to December 31, 2010 all patients with STEMI treated with primary PCI were identified. The hazard ratio (HR) for death was estimated using a Cox regression model, controlling for potential confounders. RI was defined as creatinine clearance (CrCl) < 60 mL/min (moderate RI: CrCl ≤30 < 60 mL/min and severe RI: CrCl < 30 mL/min).ResultsThe study cohort consisted of 4,116 patients of whom 898 (21.8%) had RI and 3,218 (78.2%) had a CrCl ≥ 60 mL/min. Compared to patients without RI, patients with RI were older, more often female and more likely to have diabetes mellitus, hypertension and to present with a higher Killip class.Among patients with a preserved kidney function and patients with RI, 30-day all-cause mortality was 3.5% vs. 20.9% (log-rank p < 0.001); 1-year all-cause mortality was 5.7% vs. 29.4% (log-rank p < 0.001); 5-year all-cause mortality was 13.4% vs. 47.4% (log-rank p < 0.001). Moderate and severe RI were associated with higher 1-year mortality compared to patients with a preserved renal function (CrCl ≤30 < 60 mL/min: adjusted HR 2.71 [95% CI 2.09-3.51], p < 0.001), and (CrCl < 30 mL/min: adjusted HR 7.09 [4.82-10.44], p < 0.001).ConclusionIn unselected STEMI patients treated with primary PCI, moderate and severe RI were associated with increased risk of mortality.
Highlights
Chronic kidney disease is associated with increased risk of mortality
A total of 4,676 consecutive patients were treated with primary percutaneous coronary intervention (PCI) for segment elevation myocardial infarction (STEMI) or new onset LBBB myocardial infarction (MI) at Odense University Hospital between January 1, 2002 and December 31, 2010
The final study population consisted of 4,116 patients; of these were 898 patients diagnosed with renal insufficiency (RI), defined as creatinine clearance (CrCl) < 60 mL/min per 1.73 m2, and 3,218 patients had a preserved kidney function (Figure 1)
Summary
Chronic kidney disease is associated with increased risk of mortality. We examined the impact of moderate and severe renal insufficiency (RI) on short- and long-term mortality among unselected patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). Chronic kidney disease (CKD) is found to be strongly associated with an increased risk of myocardial infarction (MI) and CVD mortality [5,6]. Data from the Western Denmark Heart Registry (WDHR) were used in order to assess the impact of moderate and severe renal insufficiency (RI) on short- and long-term mortality among unselected STEMI patients treated with primary PCI. Primary PCI has been the recommended treatment for STEMI after publication of the results of the DANish trial in Acute Myocardial Infarction-2 (DANAMI-2) in 2003 [13]
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