Prognostic Implications of Chronic Kidney Disease on Patients Presenting with ST-Segment Elevation Myocardial
Gilad Margolis1, Shahar Vig1, Nir Flint1
1Department of Cardiology, Tel Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Chronic kidney disease (CKD) significantly increases long-term mortality risk in ST-segment elevation myocardial infarction (STEMI) patients after percutaneous coronary intervention. Stent thrombosis (ST) did not impact long-term survival in this patient group.
Area of Science:
- Cardiology
- Nephrology
- Clinical Outcomes Research
Background:
- Limited data exists on long-term outcomes for chronic kidney disease (CKD) patients experiencing stent thrombosis (ST).
- This study investigates the impact of CKD on long-term mortality in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI).
- The interaction between CKD and ST on mortality was also examined.
Purpose of the Study:
- To determine the independent effect of CKD on long-term mortality in STEMI patients undergoing primary PCI.
- To assess whether stent thrombosis (ST) influences long-term mortality in STEMI patients, particularly in the context of CKD.
Main Methods:
- Retrospective analysis of 1,722 STEMI patients treated with primary PCI.
- Baseline CKD defined as estimated glomerular filtration rate <60 mL/min/1.73 m².
- Stent thrombosis (ST) assessed using Academic Research Consortium criteria; long-term mortality was the primary endpoint.
Main Results:
- 26% of patients had baseline CKD, presenting with more comorbidities and higher ST rates (7% vs 4%).
- CKD was associated with significantly higher long-term mortality (17.6% vs 2.7%, p < 0.001).
- CKD independently predicted long-term mortality (HR 2.04, p=0.01), while ST did not significantly affect mortality in either CKD or non-CKD groups.
Conclusions:
- Chronic kidney disease (CKD) is a significant independent predictor of long-term mortality in STEMI patients treated with primary PCI.
- Stent thrombosis (ST) does not appear to be a significant predictor of long-term mortality in this population.
Background:
Limited data is present regarding long-term outcomes in chronic kidney disease (CKD) patients presenting with stent thrombosis (ST). We evaluated the possible implications of CKD on long-term mortality in patients presenting with ST-segment elevation myocardial infarction (STEMI) and treated with primary percutaneous coronary intervention (PCI), and its interaction with the presence of ST.
Methods:
We retrospectively studied 1,722 STEMI patients treated with primary PCI. Baseline CKD was categorized as an estimated glomerular filtration rate <60 mL/min/1.73 m2 at presentation. The presence of ST was determined using the Academic Research Consortium definitions. Patients were evaluated for the presence of CKD and ST, as well as for long-term mortality.
Results:
A total of 448/1,722 (26%) patients had baseline CKD. Patients with CKD were older and had more comorbidities and a higher rate of ST (4 vs. 7%, respectively, p < 0.001). In a univariate analysis, long-term mortality was significantly higher among those with CKD compared to those without CKD (17.6 vs. 2.7%, p < 0.001). The presence of ST did not alter long-term mortality in both CKD and no-CKD patients. In a Cox regression model, CKD was an independent predictor of long-term mortality (hazard ratio 2.04, 95% confidence interval 1.17-3.56, p = 0.01), while ST as a covariate was not significantly associated with long-term mortality.
Conclusion:
Among STEMI patients, CKD, but not ST, is a predictor of long-term mortality.
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