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Delayed PCI is not beneficial for STEMI patients with impaired renal function: a retrospective cohort study
Yi Lao1, Kaitong Chen2, Li Feng3
1Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Heart Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong province, China.
Insights
For ST-segment elevation myocardial infarction (STEMI) patients with impaired renal function (IRF), delayed percutaneous coronary intervention (PCI) did not improve one-year survival rates. While 30-day mortality was lower with PCI, long-term benefits were not observed in this patient group.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Preexisting impaired renal function (IRF) and contrast-induced nephropathy (CIN) are critical prognostic factors in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI).
- The benefit of delayed PCI in STEMI patients with IRF remains unclear, necessitating further investigation into optimal treatment strategies.
Purpose of the Study:
- To evaluate the clinical outcomes of delayed PCI in STEMI patients with pre-existing IRF.
- To determine if PCI offers survival benefits for STEMI patients with IRF presenting late after symptom onset.
Main Methods:
- A retrospective cohort study included 164 STEMI patients with IRF presenting at least 12 hours after symptom onset.
- Patients were divided into two groups: those receiving PCI plus optimal medical therapy (OMT) and those receiving OMT alone.
- Clinical outcomes at 30 days and 1 year were compared, with survival analyzed using Cox regression.
Main Results:
- The PCI group (n=126) showed significantly lower 30-day mortality (11.1%) compared to the non-PCI group (n=38, 28.9%; P=0.018).
- However, no significant differences were observed in 1-year mortality or cardiovascular comorbidities between the groups.
- Cox regression analysis indicated that patients with IRF did not experience a survival benefit from PCI (P=0.267).
Conclusions:
- Delayed PCI does not appear to confer significant one-year clinical outcome benefits for STEMI patients with impaired renal function.
- While PCI may reduce short-term mortality, its long-term impact on survival in this specific patient population is not evident.
Background:
Preexisting impaired renal function (IRF) and contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) are important prognostic parameters, but it is unknown whether delayed PCI is still beneficial for STEMI patients with IRF.
Methods:
A retrospective single-center cohort study was performed in 164 patients who presented at least 12 h after symptom onset, and were diagnosed with STEMI and IRF. They were assigned to two groups to receive PCI plus optimal medical therapy (OMT) and OMT alone respectively. Clinical outcomes at 30 days and 1 year were compared between two groups, and hazard ratio for survival was analyzed using Cox regression model. A power analysis demanded 34 patients in each group to produce a power of 90% and a P value of 0.05.
Results:
The 30-day mortality was significantly lower in PCI group (n = 126) than in non-PCI group (n = 38) (11.1% versus 28.9%, P = 0.018), while there was no significant difference in the 1-year mortality and incidence of cardiovascular comorbidities between the two groups. Cox regression analysis showed that patients with IRF didn't benefit from receiving PCI on survival rate (P = 0.267).
Conclusions:
Delayed PCI is not beneficial on one-year clinical outcomes for STEMI patients with IRF.
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