The Prognostic Value of Serum Creatinine on Admission in Fibrinolytic-Eligible Patients with Acute Myocardial Infarction

Abstract

Previous studies have demonstrated that impaired renal function is associated with unfavourable outcomes in patients with acute coronary syndromes and following percutaneous coronary intervention. We hypothesized that serum creatinine (Cr) on admission is a useful predictor of mortality in fibrinolytic-eligible patients with ST-elevation myocardial infarction (MI). Data were collected from 352 patients with ST-elevation MI, 89% of patients underwent early invasive management. 30-day and 6-month mortality were increased among patients with mild to moderate (Cr > 1.2-2.8 mg/dl) renal dysfunction compared to patients with normal (Cr <or= 1.2 mg/dl) renal function (3.4% vs. 16.1%, p < 0.001 and 4.5% vs. 19.5%, p < 0.001). After adjustment for previously identified correlates of mortality in a multiple logistic regression model, higher Cr on admission remained independently associated with increased mortality (30-day, OR 4.78, 95%CI 1.55-14.73, p = 0.006; 6-month, 3.82 (1.45-10.11), p = 0.007). The incidence of mortality was reduced among those patients with renal dysfunction that also underwent acute percutaneous coronary intervention [30-day, OR 0.13, 95%CI 0.02-1.06, p < 0.03; 6-month, 0.23 (0.05-1.07), p < 0.05]. Cr on admission is a strong and independent predictor of mortality in patients with ST-elevation MI. This association does not appear to be mediated by reduced fibrinolytic efficacy, or by higher reinfarction rates among patients with renal dysfunction. Cr on admission is a rapid and widely available marker to identify high-risk patients with ST-elevation MI that have additional improvements in survival when treated with percutaneous coronary intervention.