title: The prognostic impact of renal failure in patients with ST-segment elevation acute myocardial infarction.
abstract: BACKGROUND
  Renal insufficiency (RI) is associated with higher morbidity and mortality in patients (P) with coronary artery disease and in P submitted to angioplasty. In ST-segment elevation acute myocardial infarction (STEAMI), this impact has not been well demonstrated.
  
  
  OBJECTIVE
  To evaluate the impact of RI in P with STEAMI.
  
  
  METHODS
  We evaluated 160 P admitted with STEAMI, mean age of 62+/-14 years, 76% male. We determined creatinine levels on admission. RI was defined as a level >1.5 mg/dl. Analysis of clinical, electrocardiographic and laboratory variables was performed, in relation to the endpoint defined as the occurrence of death at 30-day follow-up.
  
  
  RESULTS
  There were 16 deaths (10%) at 30-day follow-up. P with RI (n=21) were older (68+/-11 vs 61+/-14 years, p<0.001), more often had diabetes (57 vs 24 %, p=0.004) and presented more often with Killip class > or =2 (57 vs 12%, p<0.001). The use of statins (62 vs 83%, p=0.05) and beta-blockers (24 vs 65%, p<0.001) was lower in P with RI. Mortality was higher in RI P (62 vs 2%, p<0.001). The univariate predictors of death were age > or =75 years, diabetes, Killip class > or =2 on admission, RI, non-use of statins and beta-blockers and use of diuretics. In multivariate analysis, independent predictors of death at 30 days were RI (HR 29.6, 95% CI 6.3-139.9, p<0.001) and non-use of beta-blockers (HR 0.13, 95% CI 0.02-1.01, p=0.01).
  
  
  CONCLUSIONS
  In P admitted for STEAMI, the presence of RI was an independent predictor of death at 30 days whereas the usage of beta-blockers was protective.
authors.affiliation: Cardiology Department, Santa Maria Hospital, Lisbon, Portugal. ana_timoteo@yahoo.com
authors.forename: Ana Teresa
authors.initials: AT
authors.lastname: Timóteo
authors.forename: António
authors.initials: A
authors.lastname: Fiarresga
authors.forename: Joana
authors.initials: J
authors.lastname: Feliciano
authors.forename: Nuno
authors.initials: N
authors.lastname: Pelicano
authors.forename: Lurdes
authors.initials: L
authors.lastname: Ferreira
authors.forename: Rui
authors.initials: R
authors.lastname: Ferreira
authors.forename: José
authors.initials: J
authors.lastname: Serra
authors.forename: José
authors.initials: J
authors.lastname: Oliveira
authors.forename: Jorge
authors.initials: J
authors.lastname: Quininha
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D016001:Confidence Intervals; D003404:Creatinine / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology*; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D003404:Creatinine