title: Combined effects of admission serum creatinine concentration with age and gender on the prognostic significance of subjects with acute ST-elevation myocardial infarction in China.
abstract: OBJECTIVE
  to explore the impact of admission serum creatinine concentration on the in-hospital mortality and its interaction with age and gender in patients with acute ST-segment elevation myocardial infarction (STEMI) in China.
  
  
  METHODS
  1424 acute STEMI patients were enrolled in the study. Anthropometric and laboratory measurements were collected from every patient. A Cox proportional hazards regression model was used to determine the relationships between the admission serum creatinine level (Cr level), age, sex and the in-hospital mortality. A crossover analysis and a stratified analysis were used to determine the combined impact of Cr levels with age and gender.
  
  
  RESULTS
  Female (HR 1.687, 95%CI 1.051 ∼ 2.708), elevated Cr level (HR 5.922, 95%CI 3.780 ∼ 9,279) and old age (1.692, 95%CI 1.402 ∼ 2.403) were associated with a high risk of death respectively. After adjusting for other confounders, the renal dysfunction was still independently associated with a higher risk of death (HR 2.48, 95% CI 1.32 ∼ 4.63), while female gender (HR 1.19, 95%CI 0.62 ∼ 2.29) and old age (HR 1.77, 95%CI 0.92 ∼ 3.37) was not. In addition, crossover analysis revealed synergistic effects between elevated Cr level and female gender (SI = 3.01, SIM = 2.10, AP = 0.55). Stratified analysis showed that the impact of renal dysfunction on in-hospital mortality was more pronounced in patients <60 years old (odds ratios 11.10, 95% CI 3.72 to 33.14) compared with patients 60 to 74 years old (odds ratios 5.18, 95% CI 2.48 ∼ 10.83) and patients ≥ 75 years old (odds ratios 3.99, 95% CI 1.89 to 8.42).
  
  
  CONCLUSIONS
  Serum Cr concentration on admission was a strong predictor for in-hospital mortality among Chinese acute STEMI patients especially in the young and the female.
authors.affiliation: Department of cardiovascular medicine, the first affiliated hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
authors.forename: Zhao-Yang
authors.initials: ZY
authors.lastname: Li
authors.affiliation: Department of Cardiovascular Medicine, the Friendship Hospital of Ili Kazakh Autonomous Prefecture, Yining, XinJiang, China.
authors.lastname: Pu-Liu
authors.affiliation: Department of Cardiovascular Medicine, the Friendship Hospital of Ili Kazakh Autonomous Prefecture, Yining, XinJiang, China.
authors.forename: Zhao-Hong
authors.initials: ZH
authors.lastname: Chen
authors.affiliation: Department of Cardiovascular Medicine, the Friendship Hospital of Ili Kazakh Autonomous Prefecture, Yining, XinJiang, China.
authors.forename: Feng-Hui
authors.initials: FH
authors.lastname: An
authors.affiliation: Department of Cardiovascular Medicine, the Friendship Hospital of Ili Kazakh Autonomous Prefecture, Yining, XinJiang, China.
authors.forename: Li-Hua
authors.initials: LH
authors.lastname: Li
authors.affiliation: Department of cardiovascular medicine, the first affiliated hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
authors.lastname: Li-Li
authors.affiliation: Department of cardiovascular medicine, the first affiliated hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
authors.forename: Chang-Yan
authors.initials: CY
authors.lastname: Guo
authors.affiliation: Department of cardiovascular medicine, the first affiliated hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Gu
authors.affiliation: Department of cardiovascular medicine, the first affiliated hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of cardiovascular medicine, the first affiliated hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
authors.forename: Tie-Bing
authors.initials: TB
authors.lastname: Zhu
authors.affiliation: Department of cardiovascular medicine, the first affiliated hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
authors.forename: Lian-Sheng
authors.initials: LS
authors.lastname: Wang
authors.affiliation: Department of cardiovascular medicine, the first affiliated hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
authors.forename: Chun-Jian
authors.initials: CJ
authors.lastname: Li
authors.affiliation: Department of cardiovascular medicine, the first affiliated hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
authors.forename: Xiang-Qing
authors.initials: XQ
authors.lastname: Kong
authors.affiliation: Department of cardiovascular medicine, the first affiliated hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
authors.forename: Wen-Zhu
authors.initials: WZ
authors.lastname: Ma
authors.affiliation: Department of cardiovascular medicine, the first affiliated hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
authors.forename: Zhi-Jian
authors.initials: ZJ
authors.lastname: Yang
authors.affiliation: Department of cardiovascular medicine, the first affiliated hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
authors.forename: En-Zhi
authors.initials: EZ
authors.lastname: Jia
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D002681:China / Q000453:epidemiology; D003404:Creatinine / Q000097:blood*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D012737:Sex Factors
chemical_list: D003404:Creatinine