Impact of renal insufficiency in patients undergoing primary angioplasty for acute myocardial infarction.
BACKGROUND
The prognostic importance of renal insufficiency (RI) in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) has not been well characterized.


RESULTS
PCI was performed in 2082 AMI patients without shock presenting within 12 hours of symptom onset in a prospective, multicenter randomized trial. RI was defined as a calculated (Cockroft-Gault) creatinine clearance (CrCl) < or =60 mL/min. RI at baseline was present in 18% of patients. Compared with patients without RI, patients with RI were older and were more likely to be female; to have hypertension, peripheral vascular disease, or cerebrovascular disease; and to present in heart failure. Mortality was markedly increased in patients with versus without baseline RI both at 30 days (7.5% versus 0.8%, P<0.0001) and at 1 year (12.7% versus 2.4%, P<0.0001). Mortality rates increased incrementally for every 10-mL/min decrease in baseline CrCl. By multivariate analysis, reduced baseline CrCl was a powerful independent predictor of 30-day mortality (hazard ratio, 5.77; P<0.0001) and remained associated with reduced survival at 1 year (hazard ratio, 1.98; P=0.08). Hemorrhagic complications and transfusion requirements were also increased more than 2-fold in patients with RI, as were severe restenosis (diameter stenosis > or =70%; 20.6% versus 11.8%, P=0.024) and infarct artery reocclusion (14.7% versus 7.3%, P=0.02).


CONCLUSIONS
Baseline RI in patients with AMI undergoing primary PCI is associated with a markedly increased risk of mortality, as well as bleeding and restenosis. Novel approaches are needed to improve the otherwise poor prognosis of patients with RI and AMI.
Sadeghi
H Mehrdad
HM
William Beaumont Hospital, Royal Oak, Mich, USA.
Stone
Gregg W
GW
Grines
Cindy L
CL
Mehran
Roxana
R
Dixon
Simon R
SR
Lansky
Alexandra J
AJ
Fahy
Martin
M
Cox
David A
DA
Garcia
Eulogio
E
Tcheng
James E
JE
Griffin
John J
JJ
Stuckey
Thomas D
TD
Turco
Mark
M
Carroll
John D
JD
D000077284:Abciximab; D000208:Acute Disease; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D003287:Contrast Media / Q000009:adverse effects; D023903:Coronary Restenosis / Q000175:diagnosis / Q000517:prevention & control; D003404:Creatinine / Q000097:blood / Q000652:urine; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000139:chemically induced / Q000150:complications* / Q000175:diagnosis; D018570:Risk Assessment; D015607:Stents / Q000009:adverse effects; D015996:Survival Rate; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D003287:Contrast Media; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D003404:Creatinine; D000077284:Abciximab