title: Impact of admission creatinine level on clinical outcomes of patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention with drug-eluting stent implantation.
abstract: BACKGROUND
  Prognosis of patients with acute ST-elevation myocardial infarction (STEMI) and renal dysfunction (RD) who received primary percutaneous coronary intervention (PCI) has not been fully investigated in the drug-eluting stent (DES) era. This study aimed to evaluate the impact of admission serum creatinine level on short-term outcomes in patients with acute STEMI undergoing DES-based primary PCI.
  
  
  METHODS
  Primary PCI with DES implantation was attempted in 619 consecutive STEMI patients within 12 hours of symptom onset. Among them, 86 patients had a serum creatinine level > or = 115 micromol/L on admission (RD group), and the remaining 533 patients had normal renal function (non-RD group). The primary endpoint was 30-day major adverse cardiac events (MACE, including death, non-fatal reinfarction, and target vessel revascularization), and the secondary endpoint was subacute stent thrombosis.
  
  
  RESULTS
  Patients in the RD group were older than those in the non-RD group. There are more female patients in the RD group and they had a history of hypertension, myocardial infarction and revascularization. The occurrence rates of Killip class > or = 2 (29.1% vs 18.6%, P = 0.02) and multi-vessel (62.8% vs 44.5%, P = 0.001) and triple vessel disease (32.6% vs 18.2%, P = 0.002), in-hospital mortality (9.3% vs 3.8%, P = 0.03), and MACE rate during hospitalization (17.4% vs 7.7%, P = 0.006) were higher in the RD group than those in the non-RD group. At a 30-day clinical follow-up, the MACE-free survival rate was significantly reduced in the RD group (76.7% vs 89.9%, P = 0.0003). Angiographic stent thrombosis occurred in 3 (3.5%) and 7 (1.3%) of patients in the RD group and non-RD group, respectively (P = 0.15). Multivariate analysis revealed that the serum creatinine level > or = 115 micromol/L on admission was an independent predictor for MACE rate at a 30-day follow-up (Hazard ratio (HR) 3.31, 95% CI 1.19 - 9.18, P < 0.001).
  
  
  CONCLUSIONS
  Despite similar prevalence of stent thrombosis at a 30-day clinical follow-up, the short-term prognosis of STEMI patients with elevated serum creatinine on admission undergoing DES-based primary PCI remains unfavorable.
authors.affiliation: Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhang
authors.forename: Rui-yan
authors.initials: RY
authors.lastname: Zhang
authors.forename: Jie
authors.initials: J
authors.lastname: Shen
authors.forename: Jian-sheng
authors.initials: JS
authors.lastname: Zhang
authors.forename: Jian
authors.initials: J
authors.lastname: Hu
authors.forename: Zheng-kun
authors.initials: ZK
authors.lastname: Yang
authors.forename: Xian
authors.initials: X
authors.lastname: Zhang
authors.forename: Ai-fang
authors.initials: AF
authors.lastname: Zheng
authors.forename: Wei-feng
authors.initials: WF
authors.lastname: Shen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D003404:Creatinine / Q000097:blood*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D011379:Prognosis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003404:Creatinine