title: Prognostic value of kidney function in patients with ST-elevation and non-ST-elevation acute myocardial infarction treated with percutaneous coronary intervention.
abstract: BACKGROUND
  Patients with decreased kidney function and acute ST-elevation myocardial infarction (STEMI) and non-STEMI are less likely to receive reperfusion therapy and aggressive medical treatment. This undertreatment may contribute to the poor outcome of these patients. The prognostic value of kidney function in patients with STEMI and NSTEMI treated predominantly with percutaneous coronary intervention (PCI) and aggressive medical treatment is less known.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  2 academic centers in Germany; 4,701 consecutive patients with acute myocardial infarction (AMI) from 1998 to 2006.
  
  
  METHODS
  Estimated creatinine clearance (eCCr) at admission.
  
  
  METHODS
  The primary end point was all-cause mortality during the first year after PCI for AMI (STEMI and NSTEMI) with a prespecified landmark at 30 days (landmark analysis). Secondary end points were nonfatal myocardial infarction, stroke, and major bleeding.
  
  
  RESULTS
  Patients were divided into quartiles according to eCCr less than 56, 56 to 76, 77 to 100, and greater than 100 mL/min. Patients had an increased risk of death with decreased eCCr both within 30 days (7.7%, 3.1%, 1.4%, and 0.7% for the 4 quartiles; P < 0.001) and after 30 days (12.1%, 4.8%, 1.9%, and 1.2%; P < 0.001). The association of eCCr with mortality was similar in patients younger and older than 70 years. Major bleeding within 30 days and incidence of stroke also were more frequent with reduced eCCr. However, recurrent myocardial infarction was not associated with eCCr. After adjustment for additional baseline characteristics, kidney function based on eCCr at admission remained a strong independent predictor of mortality at 1 year after AMI (hazard ratio, 1.21 per 10-mL/min decrease; 95% confidence interval, 1.13 to 1.30).
  
  
  CONCLUSIONS
  Single assessment of eCCr.
  
  
  CONCLUSIONS
  In patients with AMI treated with primary PCI for STEMI and early PCI for NSTEMI, eCCr at admission remains a powerful independent predictor of short- and long-term mortality.
authors: Deutsches Herzzentrum München, Germany. seyfarth@dhm.mhn.de
authors: Melchior
authors: M
authors: Seyfarth
authors: Adnan
authors: A
authors: Kastrati
authors: Johannes F E
authors: JF
authors: Mann
authors: Gjin
authors: G
authors: Ndrepepa
authors: Robert A
authors: RA
authors: Byrne
authors: Stefanie
authors: S
authors: Schulz
authors: Julinda
authors: J
authors: Mehilli
authors: Albert
authors: A
authors: Schömig
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate