Impact of renal insufficiency in patients undergoing primary angioplasty for acute myocardial infarction

Circulation. 2003 Dec 2;108(22):2769-75. doi: 10.1161/01.CIR.0000103623.63687.21. Epub 2003 Nov 24.

Abstract

Background: The prognostic importance of renal insufficiency (RI) in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) has not been well characterized.

Methods and results: PCI was performed in 2082 AMI patients without shock presenting within 12 hours of symptom onset in a prospective, multicenter randomized trial. RI was defined as a calculated (Cockroft-Gault) creatinine clearance (CrCl) < or =60 mL/min. RI at baseline was present in 18% of patients. Compared with patients without RI, patients with RI were older and were more likely to be female; to have hypertension, peripheral vascular disease, or cerebrovascular disease; and to present in heart failure. Mortality was markedly increased in patients with versus without baseline RI both at 30 days (7.5% versus 0.8%, P<0.0001) and at 1 year (12.7% versus 2.4%, P<0.0001). Mortality rates increased incrementally for every 10-mL/min decrease in baseline CrCl. By multivariate analysis, reduced baseline CrCl was a powerful independent predictor of 30-day mortality (hazard ratio, 5.77; P<0.0001) and remained associated with reduced survival at 1 year (hazard ratio, 1.98; P=0.08). Hemorrhagic complications and transfusion requirements were also increased more than 2-fold in patients with RI, as were severe restenosis (diameter stenosis > or =70%; 20.6% versus 11.8%, P=0.024) and infarct artery reocclusion (14.7% versus 7.3%, P=0.02).

Conclusions: Baseline RI in patients with AMI undergoing primary PCI is associated with a markedly increased risk of mortality, as well as bleeding and restenosis. Novel approaches are needed to improve the otherwise poor prognosis of patients with RI and AMI.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abciximab
  • Acute Disease
  • Aged
  • Angioplasty, Balloon, Coronary* / adverse effects
  • Antibodies, Monoclonal / therapeutic use
  • Contrast Media / adverse effects
  • Coronary Restenosis / diagnosis
  • Coronary Restenosis / prevention & control
  • Creatinine / blood
  • Creatinine / urine
  • Female
  • Humans
  • Immunoglobulin Fab Fragments / therapeutic use
  • Male
  • Middle Aged
  • Myocardial Infarction / complications*
  • Myocardial Infarction / drug therapy
  • Myocardial Infarction / therapy*
  • Platelet Aggregation Inhibitors / therapeutic use
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Renal Insufficiency / chemically induced
  • Renal Insufficiency / complications*
  • Renal Insufficiency / diagnosis
  • Risk Assessment
  • Stents / adverse effects
  • Survival Rate
  • Treatment Outcome

Substances

  • Antibodies, Monoclonal
  • Contrast Media
  • Immunoglobulin Fab Fragments
  • Platelet Aggregation Inhibitors
  • Creatinine
  • Abciximab