Association of glomerular filtration rate with unsuccessful primary percutaneous coronary intervention and subsequent mortality in patients with acute myocardial infarction: from the HIJAMI registry.
BACKGROUND
Outcomes after percutaneous coronary intervention (PCI) for patients with acute myocardial infarction (AMI) complicated by renal insufficiency have not been well described. The aims of this study were to evaluate the association of estimated glomerular filtration rate (GFR) and risk of unsuccessful PCI for AMI, and to evaluate the prognostic importance of PCI success in patients with renal insufficiency.


RESULTS
From the Heart Institute of Japan Acute Myocardial Infarction (HIJAMI) registry, 1,706 patients undergoing primary PCI were analyzed. The adjusted odds ratios for unsuccessful PCI of GFR 30-60 and <30 ml . min(-1) . 1.73 m(-2) were 1.97 (95% confidence interval (CI): 1.22-3.18) and 2.56 (95%CI: 1.13-5.78), respectively. During the mean follow-up period of 29 months, the adjusted hazard ratios for death of successful compared with unsuccessful PCI were 1.0 (reference) compared with 2.04 (95%CI: 0.87-4.81) in the highest GFR group, 1.51 (95%CI: 1.11-2.06) compared with 2.07 (95%CI: 1.19-3.62) in the intermediate GFR group, and 2.69 (95%CI: 1.72-4.22) compared with 10.07 (95%CI: 4.91-20.5) in the lowest GFR group.


CONCLUSIONS
Decreased GFR was associated with the risk of unsuccessful primary PCI. Moreover, unsuccessful PCI was associated with strikingly poor long-term survival in patients with GFR <30 ml .min(-1) . 1.73 m(-2). Steady success is essential when using PCI for such a high-risk population.
Koganei
Hiroshi
H
Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku,Tokyo 162-8666, Japan. h-koganei@jcom.home.ne.jp
Kasanuki
Hiroshi
H
Ogawa
Hiroshi
H
Tsurumi
Yukio
Y
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D044466:Asian People; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D051437:Renal Insufficiency / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology*; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate