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Published on: January 28, 2020
Prognostic value of kidney function in patients with ST-elevation and non-ST-elevation acute myocardial infarction
Melchior Seyfarth1, Adnan Kastrati, Johannes F E Mann
1Deutsches Herzzentrum München, Germany. seyfarth@dhm.mhn.de
Insights
Reduced kidney function, indicated by estimated creatinine clearance (eCCr), significantly increases mortality risk in patients with acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI). This finding highlights the importance of assessing kidney function in AMI patients.
Area of Science:
- Cardiology
- Nephrology
- Clinical Medicine
Background:
- Patients with acute myocardial infarction (AMI), including ST-elevation myocardial infarction (STEMI) and non-STEMI, often receive less aggressive treatment if they have decreased kidney function.
- This undertreatment may lead to poorer outcomes in this vulnerable patient group.
- The prognostic impact of kidney function in AMI patients undergoing percutaneous coronary intervention (PCI) and aggressive medical management is not well-established.
Purpose of the Study:
- To investigate the prognostic value of estimated creatinine clearance (eCCr) on mortality in patients with AMI treated with PCI.
- To assess the association between kidney function and short-term (30-day) and long-term (1-year) mortality after PCI for AMI.
Main Methods:
- A prospective cohort study was conducted at two academic centers in Germany, analyzing 4,701 consecutive patients with AMI from 1998 to 2006.
- Estimated creatinine clearance (eCCr) at admission was used as the predictor of kidney function.
- The primary endpoint was all-cause mortality within one year post-PCI, with a landmark analysis at 30 days. Secondary endpoints included nonfatal myocardial infarction, stroke, and major bleeding.
Main Results:
- Patients were stratified into quartiles based on eCCr. Decreased eCCr was associated with significantly increased all-cause mortality at both 30 days and 1 year (P < 0.001 for both).
- The association between eCCr and mortality was consistent across different age groups.
- Reduced eCCr was also linked to a higher incidence of major bleeding and stroke within 30 days, but not recurrent myocardial infarction.
Conclusions:
- Estimated creatinine clearance (eCCr) at admission is a powerful and independent predictor of both short-term and long-term mortality in patients with AMI undergoing primary PCI for STEMI or early PCI for NSTEMI.
- A single assessment of eCCr provides valuable prognostic information for these patients.
Background:
Patients with decreased kidney function and acute ST-elevation myocardial infarction (STEMI) and non-STEMI are less likely to receive reperfusion therapy and aggressive medical treatment. This undertreatment may contribute to the poor outcome of these patients. The prognostic value of kidney function in patients with STEMI and NSTEMI treated predominantly with percutaneous coronary intervention (PCI) and aggressive medical treatment is less known.
Study Design:
Prospective cohort study.
Setting & Participants:
2 academic centers in Germany; 4,701 consecutive patients with acute myocardial infarction (AMI) from 1998 to 2006.
Predictor:
Estimated creatinine clearance (eCCr) at admission.
Outcomes & Measurements:
The primary end point was all-cause mortality during the first year after PCI for AMI (STEMI and NSTEMI) with a prespecified landmark at 30 days (landmark analysis). Secondary end points were nonfatal myocardial infarction, stroke, and major bleeding.
Results:
Patients were divided into quartiles according to eCCr less than 56, 56 to 76, 77 to 100, and greater than 100 mL/min. Patients had an increased risk of death with decreased eCCr both within 30 days (7.7%, 3.1%, 1.4%, and 0.7% for the 4 quartiles; P < 0.001) and after 30 days (12.1%, 4.8%, 1.9%, and 1.2%; P < 0.001). The association of eCCr with mortality was similar in patients younger and older than 70 years. Major bleeding within 30 days and incidence of stroke also were more frequent with reduced eCCr. However, recurrent myocardial infarction was not associated with eCCr. After adjustment for additional baseline characteristics, kidney function based on eCCr at admission remained a strong independent predictor of mortality at 1 year after AMI (hazard ratio, 1.21 per 10-mL/min decrease; 95% confidence interval, 1.13 to 1.30).
Limitations:
Single assessment of eCCr.
Conclusions:
In patients with AMI treated with primary PCI for STEMI and early PCI for NSTEMI, eCCr at admission remains a powerful independent predictor of short- and long-term mortality.
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