Different types of renal dysfunction in patients with acute myocardial infarction treated with percutaneous coronary intervention.
BACKGROUND
The prognostic significance of different types of renal dysfunction in patients with acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI) has not been well characterized.


METHODS
The single-center AMI registry encompassed 1,486 consecutive AMI patients treated with PCI, who were followed by mean 29.7 months. Subjects with an estimated glomerular filtration rate <60 mL/min per 1.73 m2 at baseline were selected (n = 283, 19.0%) and incorporated into the chronic kidney disease (CKD) group. The control group consisted of 1,203 subjects with normal renal function (81.0%). The CKD patients were divided into subgroups: with contrast-induced nephropathy - CKD + CIN (n = 68, 4.6%) and without - CKD-CIN (n = 215, 14.5%).


RESULTS
Remote mortality rate was significantly higher in CKD group (34.6%) and in particular subgroups: CKD + CIN (47.0%), CKD-CIN (31.0%) than in controls (9.1%, P < 0.001 for all study groups vs controls). Multivariate analysis identified CKD as an independent predictor of any-cause death in the whole population (hazard ratio [HR] 1.77, 95% confidence interval [CI] 1.60-1.94, P < 0.001). Similarly, CKD + CIN contrary to CKD-CIN had significant and independent influence on remote survival in study population (HR 2.16, 95% CI 1.95-2.37, P < 0.001).


CONCLUSIONS
CKD and its types have significant, negative influence on long-term survival in AMI patients treated with PCI. It is especially strongly expressed in those CKD patients who develop contrast-induced nephropathy, which occurrence is an independent risk factor of mortality associated with over twofold increase of death hazard.
Kowalczyk
Jacek
J
1st Department of Cardiology, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland. jacekmed@poczta.onet.pl
Lenarczyk
Radoslaw
R
Kowalski
Oskar
O
Sredniawa
Beata
B
Musialik-Lydka
Agata
A
Gasior
Mariusz
M
Polonski
Lech
L
Zembala
Marian
M
Gumprecht
Janusz
J
Kalarus
Zbigniew
Z
D000208:Acute Disease; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016022:Case-Control Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors