Reperfusion strategy for patients with renal dysfunction presenting with STEMI: which is better in the North African context?

Abstract

Background Patients with renal insufficiency experience worse prognosis after STEMI. The current guidelines do not clearly draw specific strategies for patients with renal dysfunction (RD).Aim The aim of this study is to compare primary PCI (PPCI) and thrombolysis results as well as in-hospital mortality after successful reperfusion between the RD patients (RD+) and patients with normal renal function (RD-).Methods We retrospectively reviewed data for 1,388 patients admitted for STEMI between January 1995 and October 2011. Two groups were identified: PPCI (315 patients) and thrombolysis (379 patients). Ninety patients (13%) had RD defined by creatinine levels at admission > 130 μmol/l, they were equally treated by PPCI and thrombolysis.Results In the PPCI group, despite a similar pre-procedural TIMI flow (P = 0.82), TIMI III restoring 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), probably reflecting no microvascular damage. In the thrombolysis group, successful reperfusion was also significantly lower when RD exists (58% vs. 74%, P= 0.03). After successful reperfusion, RD+ patients experienced higher in-hospital mortality in the PPCI group (29% vs. 4.3%; P< 0.001), whereas mortality was similar in the thrombolysis group (3% vs. 0%, P= 0.42).Conclusion RD reduces either PPCI or thrombolysis success, with no proven microvascular damage after PPCI. In-hospital prognosis, however, is worse in the RD group only after successful PPCI, but not after successful streptokinase thrombolysis.