ST elevation myocardial infarction and renal impairment. Does it matter how we reperfuse?

The treatment of patients with ST elevation acute myocardial infarction (STEAMI) and renal failure (RF) represents one of the most challenging problems with which the cardiologists are faced. It has been well established that patients suffering of acute coronary syndromes with concomitant renal failure have a worse outcome as compared with those with normal renal function. Leading causes for this adverse outcome are excess comorbidities in patients with renal failure, lesser use of beneficial therapies and the unique pathophysiology involved in the diseased kidney. The entire setup of abnormalities in coagulation, fibrinolysis, platelet aggregation, lipids metabolism, endothelial function and a high inflammatory state, is responsible for the increased risk of restenosis, recurrent myocardial infarction, congestive heart failure, and cardiovascular death among cardiac patients with impaired renal function. The results provided by the very small number of studies in literature evaluating methods of reperfusion in patients with ST elevation myocardial infarction and impaired renal function are very sparse, and a prospective trial to solve this therapeutic dilemma that clinicians are faced with, at the bedside of patients with STEAMI and RF is needed.