title: Impact of admission glomerular filtration rate on the development of poor myocardial perfusion after primary percutaneous intervention in patients with acute myocardial infarction.
abstract: OBJECTIVE
  We aimed to investigate the impact of admission estimated glomerular filtration rates (eGFR) on the development of poor myocardial perfusion after primary percutaneous coronary intervention (pPCI) in patients presenting with acute ST-segment-elevation myocardial infarction (STEMI).
  
  
  METHODS
  Study population consisted of 80 patients with STEMI (64 men, mean age=67.5+/-6.6 years) undergoing pPCI. Myocardial perfusion was evaluated by using thrombolysis in myocardial infarction (TIMI) myocardial perfusion grade (TMPG). Patients were divided into two groups according to TMPG after pPCI. Group 1 and 2 consisted of 40 patients with TMPGs 0-1 and 40 patients with TMPGs 2-3, respectively. GFR was calculated based on the abbreviated Modification of Diet in Renal Disease study equation.
  
  
  RESULTS
  Admission serum creatine kinase-MB isoenzyme (CKMB) levels and the percentage of lower eGFR (<60 ml/min/1.73 m2) values of the patients with TMPGs 0-1 were significantly higher than those of the patients with TMPGs 2-3 after primary PCI (P=0.007, P<0.001, respectively). Univariate analysis identified pain-to-balloon time, eGFR lower than 60 ml/min/1.73 m2, peak CKMB, and TIMI flow grade 0/1 as the predictors of poor myocardial perfusion. In multivariate analysis peak CKMB, left ventricular ejection fraction less than 35%, admission TIMI flow grade 0/1, lower eGFR and pain-to-balloon time continued to have statistically significant independent association with poor myocardial perfusion in the model. Adjusted odds ratios were calculated as 12.05 for low eGFR [P=0.005; confidence interval (CI): 2.11-68.70], 8.10 for admission TIMI grade 0/1 (P=0.04; CI: 1.37-47.91), 7.04 for pain-to-balloon time (P<0.001; CI: 2.37-20.90), 6.76 for low left ventricular ejection fraction (P=0.03; CI: 1.12-40.61), and 1.02 for CKMB (P=0.01; CI: 1.00-1.04).
  
  
  CONCLUSIONS
  Decreased GFR on admission in patients with STEMI is independently associated with the risk of poor myocardial perfusion following after primary PCI.
authors.affiliation: Department of Cardiology, Gulhane Military Medical Academy, School of Medicine, Etlik-Ankara, Turkey. benturgay@yahoo.com
authors.forename: Turgay
authors.initials: T
authors.lastname: Celik
authors.forename: Atila
authors.initials: A
authors.lastname: Iyisoy
authors.forename: Cagdas U
authors.initials: CU
authors.lastname: Yuksel
authors.forename: Selim
authors.initials: S
authors.lastname: Kilic
authors.forename: M Ilker
authors.initials: MI
authors.lastname: Yilmaz
authors.forename: E Ozgur
authors.initials: EO
authors.lastname: Akgul
authors.forename: Bekim
authors.initials: B
authors.lastname: Jata
authors.forename: Ersoy
authors.initials: E
authors.lastname: Isik
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D003326:Coronary Circulation; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D054318:No-Reflow Phenomenon / Q000209:etiology* / Q000503:physiopathology; D016017:Odds Ratio; D010343:Patient Admission; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D052279:Creatine Kinase, MB Form