Impact of Renal Insufficiency on 30-Day Outcomes in Patients with ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

摘要

Background: The benefits of primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) and renal insufficiency (RI) remain uncertain. Methods: We reviewed 809 consecutive STEMI patients treated with primary PCI with (221) and without RI (588). RI was defined as an estimated glomerular filtration rate <60 ml/min/1.73m~2. Results: The RI group had a higher percentage of prior myocardial infarction (18.6% vs. 10.0%, P=0.0010), prior stroke (7.7% vs. 4.3%, P=0.049), multivessel coronary disease (41.6% vs. 31.8%, P=0.0088), all-cause (4.5% vs. 1.4%, P=0.0065) and cardiac 30-day mortality rates (4.1% vs. 1.2%, P=0.0087). Successful reperfusion rates were similarly high in both groups (91.9% and 93.5%, P=0.40), despite the significantly higher proportion of patients with door-to-balloon times >90 min (18.1% vs. 6.3%, P<0.0001) in patients with RI. Successful compared to unsuccessful PCI decreased the all-cause 30-day mortality rates in both patients with (3.0% vs. 22.2%, P<0.0001) and without RI (0.9% vs. 7.9%, P=0.0003). When reperfusion was successful, the cardiac 30-day mortality rate was not significantly greater in patients with RI than in those without (2.5% vs. 0.7%, P=0.051). By multivariate analysis, unsuccessful reperfusion (odds ratio, 8.08; 95% confidence interval 2.69-24.3; P=0.0002) independently predicted all-cause 30-day mortality, whereas RI (odds ratio, 2.43; 95% confidence interval 0.85-6.97; P=0.098) and door-to-balloon time >90 min (odds ratio, 2.50; 95% confidence interval 0.77-8.19; P=0.13) did not. Conclusion: Extensive pre-existing atherosclerosis characterizes patients with RI developing STEMI. Aggressive PCI improves prognosis in patients with RI, and short door-to-balloon time is an important parameter conditioning the prognosis.