title: Impact of the combined left ventricular systolic and renal dysfunction on one-year outcomes after primary percutaneous coronary intervention.
abstract: BACKGROUND
  The aim of this study was to assess the impact of combined left ventricular systolic dysfunction (LVSD) and renal dysfunction (RD) on 1-year overall mortality and major adverse cardiovascular events (MACEs) (comprising cardiovascular death, nonfatal renfarction, target vessel revascularization, and nonfatal stroke) in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (pPCI).
  
  
  METHODS
  One thousand three hundred ninety eight patients with first myocardial infarction, undergoing pPCI were divided into four groups according to the presence of LVSD (ejection fraction [EF] <40%) and/or baseline RD (estimated glomerular filtration rate <60 mL/min per m(2)): Group I (no LVSD and no RD); Group II (LVSD, no RD); Group III (RD, no LVSD); Group IV (LVSD + RD).
  
  
  RESULTS
  One-year mortality rates in Groups I, II, III, and IV were 2.6%, 15.2%, 10.6%, and 34.2% and 1-year MACE rates were 5.7%, 19.5%, 17.1% and 35.7%, respectively. Patients in Groups II, III, and IV had an increased probability of 1-year overall mortality and MACE as compared to Group I. Overall mortality: Group II HR 2.1 (95% CI 1.1-4.2); Group III HR 2.1 (95% CI 1.1-4.1); Group IV HR 4.8 (95% CI 2.4-9.4); MACE: Group II HR 2.2 (95% CI 1.1-4.2); Group III HR 2.2 (95% CI 1.1-4.3); Group IV HR 5.1 (95% CI 2.6-10.1). The LVSD-RD combination was the strongest independent predictor for 1-year outcomes.
  
  
  CONCLUSIONS
  The LVSD-RD combination is associated with an approximately five-fold increase in 1-year overall mortality and MACE after pPCI. The evaluation of the renal function in patients with LVSD represents a simple method which enables a more precise stratification of the risks related to the occurrence of adverse events in long-term patient follow-up.
authors: Clinical Centre of Serbia-Emergency Hospital, Coronary Care Unit, Institute for Medical Statistics and Informatics, Belgrade, Serbia. lidijasavic@ptt.rs
authors: Lidija
authors: L
authors: Savic
authors: Igor
authors: I
authors: Mrdovic
authors: Jovan
authors: J
authors: Perunicic
authors: Milika
authors: M
authors: Asanin
authors: Ratko
authors: R
authors: Lasica
authors: Jelena
authors: J
authors: Marinkovic
authors: Zorana
authors: Z
authors: Vasiljevic
authors: Miodrag
authors: M
authors: Ostojic
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015897:Comorbidity; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D013599:Systole; D018487:Ventricular Dysfunction, Left