Reperfusion strategy for patients with renal dysfunction presenting with STEMI

Abstract

Patients with renal insufficiency experience worse prognosis after STEMI. The current guidelines do not clearly draw specific strategies for patients with renal dysfunction (RD). 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−). We retrospectively reviewed data for 1785 patients admitted for STEMI between January 2007 and October 2017. Two groups were identified: PPCI (624 patients) and thrombolysis (679 patients). Hundred and twenty-two patients had RD defined by creatinine levels at admission > 130 umol/L, they were equally treated by PPCI and thrombolysis. In the PPCI group, despite a similar pre-procedural TIMI flow (P = 0.54), TIMI III restoring was significantly lower in the RD+ group (74.1% vs. 93.2%, p = 0.01). Suboptimal result was also higher in the RD+ group (15.6% vs. 3.2%, P < 0.001), but ST regression after TIMI III achievement was similar in the 2 groups (P = 0.62), probably reflecting no microvascular damage. In the thrombolysis group, successful reperfusion was also significantly lower when RD exists (51% vs. 78%, P = 0.02). After successful reperfusion, RD+ patients experienced higher in-hospital mortality in the PPCI group (11.2% vs. 3.1%; P < 0.001), whereas mortality was similar in the thrombolysis group (3.1% vs. 0.3%, P = 0.75). 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.