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Am J Med Sci. 2013 Feb;345(2):104-11. doi: 10.1097/MAJ.0b013e318258f482.

Estimated glomerular filtration rate as a useful predictor of mortality in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.

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1
Department of Internal Medicine, Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Abstract

BACKGROUND:

This study evaluated the impact of estimated glomerular filtration rate (eGFR) on 30-day and 1-year mortalities in patients with an acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).

METHODS:

Between January 2002 and November 2009, 1432 consecutive patients who had experienced STEMI with an onset of chest pain <12 hours of undergoing primary PCI were prospectively enrolled. Patients were categorized into group 1 (eGFR <30 mL/min/1.73 m(2)), group 2 (eGFR = 30-60 mL/min/1.73 m(2)) and group 3 (eGFR >60 mL/min/1.73 m(2)).

RESULTS:

The incidence of a high Killip class (defined as class ≥3) upon presentation, a requirement for mechanical ventilatory support for respiratory failure and intra-aortic balloon pump support for hemodynamic instability, and duration of hospitalization were substantially higher in group 1 than in groups 2 and 3, and notably higher in group 2 compared with group 3 (all P < 0.001). Conversely, the procedural success of primary PCI was remarkably lower in group 1 compared with groups 2 and 3, and it was also notably lower in group 2 than in group 3 (all P < 0.001). Additionally, both 30-day and 1-year mortalities were markedly increased in group 1 than in groups 2 and 3, and significantly higher in group 2 than in group 3 (all P < 0.001). Multivariate analysis showed that eGFR <30 mL/min/1.73 m(2) was a significantly independent predictor of 30-day and 1-year mortalities (all P < 0.001).

CONCLUSIONS:

eGFR <30 mL/min/1.73 m(2) was strongly and independently predictive of poor short-term and long-term prognostic outcomes in patients with STEMI undergoing primary PCI.

PMID:
23276890
DOI:
10.1097/MAJ.0b013e318258f482
[Indexed for MEDLINE]
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