The prognostic impact of renal failure in patients with ST-segment elevation acute myocardial infarction.
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.
Timóteo
Ana Teresa
AT
Cardiology Department, Santa Maria Hospital, Lisbon, Portugal. ana_timoteo@yahoo.com
Fiarresga
António
A
Feliciano
Joana
J
Pelicano
Nuno
N
Ferreira
Lurdes
L
Ferreira
Rui
R
Serra
José
J
Oliveira
José
J
Quininha
Jorge
J
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
D003404:Creatinine