Creatinine clearance is independently associated with one year mortality in a primary PCI cohort with cardiogenic shock.
BACKGROUND
Acute ST-segment elevation myocardial infarction (STEMI) complicated with cardiogenic shock (CS) has still the highest in hospital mortality. Patients with STEMI and increasing creatinine levels within 24 h after admission have a poor prognosis. Data about STEMI complicated with CS and kidney function are sparse. We sought to assess the prognostic value of creatinine clearance on admission in patients with STEMI and CS treated with percutaneous coronary intervention (PCI).


RESULTS
Between 1997 and 2005, a total of 3038 patients presented with STEMI and treated with PCI. On admission 292 patients presented with CS. Creatinine clearance (CrCl) could be calculated in 193 patients and classified in tertiles: group I > 96.8 ml/min; Group II between 67.5 and 96.8 ml/min; Group III < 67.5 ml/min. Overall one year mortality was 34%. In group I, II and III mortality was 24%, 30% and 45% respectively (P for trend 0.009). In multivariate logistic regression analysis, the odds for mortality increased with 96% for each tertile of admission CrCl (OR 1.961, 95%CI 1,135-3.385, P=0.016).


CONCLUSIONS
Creatinine clearance on admission is strongly associated with one year mortality in STEMI patients with CS on admission and treated with PCI.
Vis
M Marije
MM
Department of Cardiology, Academical Medical Centre, Amsterdam, The Netherlands.
V d Schaaf
Réne J
RJ
Sjauw
Krishan D
KD
Tijssen
Jan G P
JG
Baan
Jan
J
Koch
Karel T
KT
De Winter
Robbert J
RJ
Piek
Jan J
JJ
Henriques
José P S
JP
D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D015415:Biomarkers / Q000378:metabolism; D003404:Creatinine / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000378:metabolism / Q000401:mortality* / Q000628:therapy; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D003404:Creatinine