title: Prognostic effect of renal dysfunction after ST-segment elevation myocardial infarction with and without heart failure.
abstract: OBJECTIVE
  The present study was designed to assess, 1) the independent prognostic effect of renal dysfunction on all-cause mortality in the setting of acute myocardial infarction with ST-segment elevation (STEMI), and 2) to determine if such effect varies based upon the presence of heart failure (HF) on admission.
  
  
  METHODS
  549 consecutive patients admitted with the diagnosis of STEMI were prospectively recruited in a teaching hospital in Spain. Serum creatinine (sCr) and glomerular filtration rate (GFR) were obtained on admission, together with other relevant information used for risk stratification. The independent effect of sCr and GFR on long-term mortality was determined by Cox regression analysis. Main outcome was all-cause mortality, with a median follow-up of 1 year.
  
  
  RESULTS
  In a multivariate analysis the degree of renal impairment was a strong predictor of mortality in patients without clinical evidence of HF at admission (HR=1.15; 95% CI 1.10 to 1.19 and HR=1.58; 95% CI 1.30 to 1.81) for sCr (per 0.1 mg/dl) and GFR (per decreasing 10 ml/min/1.73 m2), respectively. In the group with HF, the effect was less pronounced (HR=1.03; 95% CI 1.01 to 1.04 and HR=1.17; 95% CI 1.02 to 1.37) for sCr and GFR, respectively.
  
  
  CONCLUSIONS
  In the setting of STEMI, renal dysfunction estimates showed a differential prognostic effect depending on HF status, with a greater impact seen in patients without clinical evidence of HF.
authors.affiliation: Cardiology Department, Valencia Clinic University Hospital, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain. vbertog@secardiologia.es
authors.forename: Vicente
authors.initials: V
authors.lastname: Bertomeu-Gonzalez
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
authors.forename: Eduardo
authors.initials: E
authors.lastname: Núñez
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Fácila
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.forename: Vicent
authors.initials: V
authors.lastname: Bodí
authors.forename: Mauricio
authors.initials: M
authors.lastname: Pellicer
authors.forename: María J
authors.initials: MJ
authors.lastname: Bosch
authors.forename: Angel
authors.initials: A
authors.lastname: Martínez
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Chorro
authors.forename: Angel
authors.initials: A
authors.lastname: Llàcer
mesh_terms: D000368:Aged; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality* / Q000503:physiopathology*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D013318:Stroke Volume; D016019:Survival Analysis
chemical_list: D003404:Creatinine