Impact of cardiac and renal dysfunction on inhospital morbidity and mortality of patients with acute myocardial infarction undergoing primary angioplasty.
BACKGROUND
Risk stratification of patients with ST-elevation myocardial infarction (STEMI) undergoing primary angioplasty is important in order to predict outcomes and to delineate targeted therapeutic strategies. Although the prognostic implications of reduced left ventricular ejection fraction (LVEF) and creatinine clearance (CrCl) have been recognized, the clinical and prognostic impact of their combination has never been prospectively evaluated.


METHODS
We stratified 467 patients with STEMI undergoing primary angioplasty according to LVEF and CrCl values at admission: CrCl > 60 mL/min and LVEF > 40% (group 1, n = 261); CrCl < or = 60 mL/min and LVEF > 40% (group 2, n = 113); CrCl > 60 mL/min and LVEF < or = 40% (group 3, n = 60); CrCl < or = 60 mL/min and LVEF < or = 40% (group 4, n = 33).


RESULTS
Inhospital mortality was different in the 4 groups (1% in group 1, 3% in group 2, 15% in group 3, 30% in group 4) (P < .001). The incidence of combined end point of death, acute pulmonary edema, cardiogenic shock, and acute renal failure requiring mechanical support increased progressively from group 1 to group 4 (5%, 17%, 33%, and 48%, respectively) (P < .001). We found a significant gradient of risk in terms of inhospital mortality and combined end point when patients outcome was evaluated according to the presence of both normal LVEF and CrCl (group 1), impairment in only 1 of these 2 parameters (group 2 and 3 pooled together), and combined LVEF and CrCl reductions (group 4).


CONCLUSIONS
Reduced LVEF and CrCl are strong independent predictors of increased inhospital morbidity and mortality, and their combined evaluation provides a simple tool for early risk stratification in patients with STEMI treated with primary angioplasty.
Marenzi
Giancarlo
G
Centro Cardiologico Monzino, I.R.C.C.S, Institute of Cardiology, University of Milan, Milan, Italy. giancarlo.marenzi@ccfm.it
Moltrasio
Marco
M
Assanelli
Emilio
E
Lauri
Gianfranco
G
Marana
Ivana
I
Grazi
Marco
M
Rubino
Mara
M
De Metrio
Monica
M
Veglia
Fabrizio
F
Bartorelli
Antonio L
AL
D058186:Acute Kidney Injury / Q000453:epidemiology; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015984:Causality; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000453:epidemiology; D051437:Renal Insufficiency / Q000453:epidemiology*; D018570:Risk Assessment / Q000379:methods; D012770:Shock, Cardiogenic / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology*