[Renal and cardiac functions as prognostic factors after revascularization for myocardial infarction]

In the last few decades optimal treatment of myocardial infarction has been achieved by thrombolytic and interventional reperfusion as well as subsequent secondary pharmacological prevention. It remains a subject of debate what factors influence prognosis after such measures.

939 patients who had sustained acute myocardial infarction (75.1% males, aged 62.5 10.1 years) were followed prospectively after revascularization, using a multicenter registry (PreSCD) registry. Date and site of infarction, reperfusion measures, cardiovascular risk factors, hemoglobin and creatinine, QRS duration, ventricular arrhythmias recorded by Holter ECG monitoring were recorded, as well as biplane left ventricular ejection fraction (LVEF). Multivariate logistic Cox regression analysis was used to determine the effect of these various factors on overall mortality, resuscitation outcome, ventricular tachycardia, re-infarction, syncope and interventional or surgical revascularization.

Complete data were collected on 926 patients (98.6%). During the follow-up period of 578 47 days there were 39 deaths (4.2%), 29 of them due to cardiac reasons, predominantly sudden cardiac death (58.6%). The occurrence of left bundle branch block was associated overall with a sevenfold increase in the of death (hazard ratio [95% confidence interval, (CI) 6.940 (2.912-16.539); p<0.0001), while an increase of serum creatinine by 1 mol/l raised the overall mortality by 0.7% (Hazard ratio (95% CI) 1.007 (1.03-1.012); p<0.001]. Improvement of LVEF by 1 % was associated with a 5% reduction in mortality risk (Hazard ratio [95% CI] 0.946 (0.918-0.975); p<0.0001]. Conventional cardiovascular risk factors, previous revascularization measures, site of infarction and pharmacological treatment failed to show any significant influence on end-points.

In patients who had revascularization measures after a myocardial infarction the mortality rate was less than 5%. The risk of death was determined by LVEF, occurrence of left bundle branch block and renal failure.