title: The impact of renal insufficiency on in-hospital outcome in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary interventions.
abstract: BACKGROUND
  Chronic renal disease (CRD) is a well-known risk factor for bleeding complications in acute coronary syndrome patients.
  
  
  OBJECTIVE
  To determine the impact of CRD with ST segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI) on periprocedural complications.
  
  
  METHODS
  103 patients with STEMI treated with pPCI were prospectively observed for in-hospital complications and analysed according to kidney function status. Endpoints included clinical and periprocedural outcomes. Major and minor bleedings were reported according to TIMI, REPLACE2 and EASY classifications.
  
  
  RESULTS
  Patients with CRD were at greater risk of major bleeding defined by RAPLACE-2 (20.0% vs. 2.7%; p = 0.007) and TIMI(13.3% vs. 1.3%, p = 0.018) classifications and had more grade 2 EASY scale haematomas (20.0% vs. 2.7%; p = 0.007). Vascular access crossover during PCI occurred eight-fold more often among CRD patients (33.3% vs. 4.0%, p < 0.001). Grade 3 TIMI flow was achieved less frequently in CRD patients (60% vs. 89.3%, p = 0.004). CRD predisposed to contrast-induced nephropathy (35.7% vs. 5.7%; p < 0.001) and ischaemic stroke (14.3% vs. 0.0%; p = 0.004).
  
  
  CONCLUSIONS
  CRD in STEMI patients undergoing pPCI is a risk factor for major and minor bleeding complications including major bleeding, moderate haematomas, contrast-induced nephropathy and ischaemic stroke. Treatment and diagnostic measures should be taken in CRD patients to reduce the severity of periprocedural complications.
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Kołtowski
authors.forename: Adam
authors.initials: A
authors.lastname: Lewandowski
authors.forename: Karolina
authors.initials: K
authors.lastname: Chojnacka
authors.forename: Krzysztof J
authors.initials: KJ
authors.lastname: Filipiak
authors.affiliation: 1st Department of Cardiology, Medical University of Warsaw. jkochman@tlen.pl.
authors.forename: Janusz
authors.initials: J
authors.lastname: Kochman
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Opolski
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D051437:Renal Insufficiency / Q000209:etiology*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome