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Renal Dysfunction and hsCRP Predict Long-term Outcomes of Percutaneous Coronary Intervention in Acute Myocardial
Chong-Hui Wang1, Shu-Yang Zhang, Quan Fang
1Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
This study shows that low estimated glomerular filtration rate (eGFR) and high high-sensitivity C-reactive protein (hsCRP) levels significantly increase long-term mortality and heart attack risk in patients after ST-segment elevation myocardial infarction (STEMI) treatment. Combining these markers offers crucial prognostic information for patient outcomes.
Area of Science:
- Cardiology
- Nephrology
- Biomarkers
Background:
- Elevated C-reactive protein (CRP) and renal dysfunction independently predict mortality and cardiovascular events post-PCI.
- Limited data exists on the long-term prognostic utility of these markers in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
Purpose of the Study:
- To evaluate the combined predictive value of estimated glomerular filtration rate (eGFR) and high-sensitivity C-reactive protein (hsCRP) for long-term mortality and cardiovascular outcomes.
- To assess the prognostic significance of these biomarkers in patients with acute STEMI treated with primary PCI.
Main Methods:
- 262 patients with acute STEMI undergoing primary PCI were stratified by eGFR and hsCRP levels.
- Mortality, nonfatal myocardial infarction (MI), and major adverse cardiac events (MACE) were compared across risk groups.
- Median follow-up was 48.3 months.
Main Results:
- The lowest eGFR group had significantly higher mortality + MI rates (35.09%) compared to other eGFR groups (P < 0.0001).
- Elevated hsCRP (≥3 mg/L) was associated with higher mortality + MI (34.29%) versus hsCRP <3 mg/L (4.41%, P < 0.0001).
- Combined low eGFR and high hsCRP showed a markedly increased hazard ratio (44.658) for adverse outcomes.
Conclusions:
- Renal dysfunction and elevated hsCRP are significant predictors of long-term MACE in STEMI patients post-PCI.
- The combination of low eGFR and high hsCRP holds strong prognostic value for long-term mortality and MI in this patient cohort.
Background:
This study assessed the combined utility of estimated glomerular filtration rate (eGFR) and serum high-sensitivity C-reactive protein (hsCRP) levels to predict long-term mortality and cardiovascular outcomes of patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Elevated CRP levels and renal dysfunction have both been shown to independently and jointly predict mortality and cardiovascular outcomes after PCI in the short term. However, long-term results in patients with acute STEMI undergoing PCI have not been reported.
Methods:
A total of 262 patients with acute STEMI undergoing primary PCI were classified at admission into quartiles according to eGFR (<60, 60-70, 70-80 and ≥80 mL·min·1.73 m) and hsCRP (<3 and ≥3 mg/L). Mortality, nonfatal myocardial infarction (MI) and major adverse cardiac events (MACEs) were compared among the groups.
Results:
During a median follow-up of 48.3 months, the composite of all-cause mortality and nonfatal MI (mortality + MI) was significantly higher (35.09%) in the group with the lowest eGFR compared with that of the other 3 eGFR groups (14.29%, 3.77% and 9.43%, respectively, P < 0.0001) and the group with elevated hsCRP (34.29%) versus that with hsCRP <3 mg/L (4.41%, P < 0.0001). A combined analysis showed an exaggerated hazard in patients with the lowest eGFR and highest hsCRP (hazard ratio: 44.658; 95% confidence interval: 5.955-111.890).
Conclusions:
Renal dysfunction and elevated hsCRP predict a high long-term incidence of MACE in patients with acute STEMI undergoing primary PCI, with the combination being of prognostic significance for long-term mortality and MI in these patients.
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