Background Renal impairment is associated with increased cardiovascular mortality following acute coronary syndromes (ACS), however there is limited data assessing this relationship in the context of primary PCI and whether it exists with other major adverse cardiovascular events.
Methods Clinical information was analysed from a prospective data base on 2310 STEMI patients who underwent primary PCI between January 2004 and May 2010 at a London centre. Information was entered at the time of procedure and outcome assessed by all-cause mortality information provided by the Office of National Statistics via the BCIS/CCAD national audit. Estimated glomerular filtration rate (eGFR) was calculated using the modified diet in renal disease equation and patients were divided into groups based on eGFR (<40, 40–50, 50–60, >60 ml/min/1.73 m2). 3-year composite of MACE (death, reinfarction, stroke and target vessel revascularisation) were compared between groups.
Results The average eGFR in all patients was 73.40±23.37 (95% CI 72.25 to 74.56) ml/min/1.73 m2. The prevalence of coexisting risk factors (hypertension, diabetes mellitus, hypercholesterolaemia), previous MI, previous CABG and cardiogenic shock were higher among patients with reduced eGFR. There was a progressive increase in MACE with declining eGFR (OR=4.84, 95% CI 2.94 to 7.96, for comparison between the highest and lowest eGFR groups). See Abstract 46 figure 1. After adjustment for baseline characteristics including age, diabetes and cardiogenic shock renal function based on the GFR at admission remained a strong independent predictor of outcome.
Conclusion Baseline renal dysfunction in patients undergoing primary PCI is associated with an increased risk for combined death, re-infarction and recurrent angina. This risk increases linearly with declining eGFR.
- Renal function
- percutaneous coronary intervention
- ST-elevation myocardial infarction