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Catheter Cardiovasc Interv. 2019 Feb 15;93(S1):793-799. doi: 10.1002/ccd.28060. Epub 2019 Jan 13.

Impact of baseline estimated glomerular filtration rate on inhospital outcomes of patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: A China acute myocardial infarction registry study.

Jia S1,2, Zhao Y1,2, Yang J1,2, Zhao X1,2, Xu H1,2, Gao R1,2, Wang Q3, Li J4, Yuan J1,2, Yang Y1,2.

Author information

1
Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
2
Peking Union Medical College, Beijing, People's Republic of China.
3
Department of Cardiology, The First Hospital of Qinhuangdao City, Qinhuangdao, Hebei Province, China.
4
Department of Cardiology, Weinan Central Hospital, Weinan, Shanxi Province, China.

Abstract

OBJECTIVE:

To explore the relationship between inhospital outcomes and different estimated glomerular filtration rates (eGFRs) and determine an optimal eGFR cutoff value for predicting risk in patients with renal insufficiency (RI).

BACKGROUND:

RI is a predictor of poor prognosis in patients with myocardial infarction undergoing primary percutaneous coronary intervention (PCI). However, the cutoff value of the eGFR is questionable.

METHODS:

We included 10,240 patients with ST segment elevation myocardial infarction (STEMI) undergoing primary PCI from January 2013 to January 2016 who participated in the China Acute Myocardial Infarction registry. RI was defined as eGFR <60 mL/min/1.73 m2 . Patients were stratified into five eGFR groups to determine the optimal cutoff value: <30, 30-45, 45-60, 60-90, and > 90 mL/min/1.73 m2 .

RESULTS:

Overall, 1,112 (10.9%) patients had eGFR <60 mL/min/1.73 m2 . Patients with eGFR<60 mL/min/1.73 m2 had a significantly higher incidence of all-cause death and major adverse cardiovascular and cerebrovascular events (MACCEs) than those with eGFR >60 mL/min/1.73 m2 . Occurrence trend test analysis revealed that the incidence of inhospital all-cause death and MACCEs increased as the eGFR decreased. In logistic multivariate-adjusted analysis, eGFR <45 mL/min/1.73 m2 was associated with a higher incidence of all-cause death and MACCEs than eGFR >90 mL/min/1.73 m2 .

CONCLUSIONS:

RI is common among patients with STEMI undergoing primary PCI. A low eGFR is an indicator of worse inhospital prognosis. We suggest an eGFR cutoff value of 45 mL/min/1.73 m2 to predict inhospital deaths and MACCEs.

KEYWORDS:

mortality; prognosis; renal insufficiency

PMID:
30637931
DOI:
10.1002/ccd.28060

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