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Original article
Mild chronic kidney disease is an independent predictor of long-term mortality after emergency angiography and primary percutaneous intervention in patients with ST-elevation myocardial infarction
  1. Niall G Campbell1,
  2. Mira Varagunam1,
  3. Vinit Sawhney2,
  4. Kumar R Ahuja2,
  5. Nabila Salahuddin2,
  6. Rodney De Palma2,
  7. Martin T Rothman2,
  8. Andrew Wragg2,
  9. Muhammed M Yaqoob1,
  10. Charles J Knight2
  1. 1William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  2. 2London Chest Hospital, Barts and the London NHS Trust, London, UK
  1. Correspondence to Dr Charles Knight, Department of Cardiology, London Chest Hospital, Barts and the London NHS Trust, Bonner Road, London E2 9JX, UK; charles.knight{at}bartsandthelondon.nhs.uk

Abstract

Objective Moderate renal impairment (RI) with a glomerular filtration rate (GFR) <60 ml/min/1.73 m2 is known to predict survival. The authors investigated whether mild RI with an estimated GFR of 60–89 ml/min/1.73 m2 independently predicts survival in a contemporary population with ST segment elevation myocardial infarction (STEMI).

Design This is a single-centre, observational, retrospective cohort study.

Patients 601 patients with STEMI who underwent emergency catheter laboratory admission met the inclusion criteria for this study.

Methods Estimated glomerular filtration rate (eGFR) was obtained by the Modified Diet in Renal Disease equation, and preprocedure renal function was subdivided into chronic kidney disease stages. Univariate and multivariate Cox regression analyses were performed to assess which of 17 patient or procedural variables were independent risk factors for death.

Results Longitudinal data were collated for 576 patients (96.3%). Median follow-up time was 2.6 years. 30-day and long-term death rates were 5.7% and 12.5%, respectively. Following multivariable analysis, mild RI with an eGFR of 60–89 ml/min/1.73 m2 was a strong independent predictor of death, compared with an eGFR ≥90 ml/min/1.73 m2 (HR 2.79, 95% CI 1.98 to 3.92, p<0.001), and increasing chronic kidney disease stage was a strong predictor of death after both 30 days and long-term follow-up. An eGFR of 60–89 ml/min/1.73 m2 had a greater independent effect on short- and long-term mortality than the presence of diabetes mellitus (HR 2.0, 95% CI 1.2 to 3.33).

Conclusion Mild RI (eGFR=60–89 ml/min/1.73 m2) on admission is strongly predictive of short- and long-term mortality in patients with STEMI admitted to the catheter laboratory. A redefined threshold of clinically significant impairment is now required (GFR<90 ml/min/1.73 m2).

  • Sudden cardiac death
  • adhesion molecule
  • pacemakers
  • renal disease
  • implantable cardioverter defibrillator (ICD)
  • arrhythmias
  • atrial fibrillation
  • ventricular tachycardia
  • endocarditis
  • interventional catheters
  • valve disease
  • vascular biology
  • endothelial cells
  • acute coronary syndrome
  • hypertrophic cardiomyopathy
  • platelet and angioplasty
  • stents

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Footnotes

  • Muhammed M Yaqoob and Charles J Knight are joint final authors.

  • Funding Barts and the London National Institute of Health Research Cardiovascular Biomedical Research Unit, London, UK.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by NRES Committee; London—City and East.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The authors will freely share anonymised patient data for CKD classes and mortality, on request. Ethical approval for data sharing has not yet been sought; this is pending.

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