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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Relation of in-hospital serum creatinine change patterns and outcomes among ST-segment elevation myocardial
Yacov Shacham1, Eran Leshem-Rubinow1, Amir Gal-Oz2
1Department of Cardiology, Tel-Aviv University, Tel-Aviv, Israel.
Insights
In ST-segment elevation MI (STEMI) patients, worsening serum creatinine (sCr) after percutaneous coronary intervention (PCI) indicates poor outcomes. However, improved sCr levels post-PCI do not correlate with adverse events.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Worsening serum creatinine (sCr) is common in ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PCI), linked to poor outcomes.
- The prognostic significance of improved sCr levels during hospitalization post-PCI remains unclear.
Purpose of the Study:
- To investigate the incidence and prognostic implications of changes in sCr levels (worsening or improvement) during hospitalization in STEMI patients undergoing primary PCI.
- To compare outcomes between patients with stable, worsened, or improved sCr levels.
Main Methods:
- Retrospective study of 1260 STEMI patients who underwent primary PCI.
- Categorization of patients based on sCr changes: stable, worsened (>0.3 mg/dL increase), or improved (>0.3 mg/dL decrease) from admission levels.
- Comparison of in-hospital complications and long-term mortality across the sCr change groups.
Main Results:
- 10% of patients experienced worsening sCr, while 3.5% showed improvement.
- Worsening sCr was associated with increased in-hospital complications and significantly higher 30-day and 5-year mortality (HR 6.68).
- No significant differences in complications or mortality were observed between patients with improved sCr and those with stable sCr.
Conclusions:
- In STEMI patients undergoing primary PCI, worsening renal function (indicated by sCr increase) is a frequent finding with adverse prognostic implications.
- Conversely, improvement in sCr levels during hospitalization is not associated with adverse short-term or long-term outcomes.
Background:
The worsening of serum creatinine (sCr) level is a frequent finding among ST-segment elevation MI (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), associated with adverse short-term and long-term outcomes. No information is present, however, regarding the incidence and prognostic implications associated with an improvement in sCr levels throughout hospitalization, as compared with admission levels.
Hypothesis:
Reversible renal impairment prior to PCI is not associated with adverse outcomes.
Methods:
We retrospectively studied 1260 STEMI patients undergoing primary PCI. The incidence of in-hospital complications and long-term mortality was compared between patients having stable, worsened (>0.3 mg/dL increase), or improved (>0.3 mg/dL decrease) sCr levels throughout hospitalization.
Results:
Overall, 127 patients (10%) had worsening in sCr levels, whereas 44 (3.5%) had an improvement of sCr compared with admission levels. Patients with worsening sCR had more complications during hospitalization, higher 30-day (13% vs 1%; P < 0.001) and up to 5-year all-cause mortality (28% vs 5%; P < 0.001) compared with those with stable sCR. No significant difference was found regarding complications and mortality between patients having an improvement in sCr and stable sCr. Compared with patients with stable sCr, the adjusted hazard ratio for all-cause mortality in patients with worsened sCr was 6.68 (95% confidence interval: 2.1-21.6, P = 0.002).
Conclusions:
In STEMI patients undergoing primary PCI, renal impairment prior to PCI is a frequent finding. In contrast to post-PCI sCr worsening, this entity is not associated with adverse short-term and long-term outcomes.
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