Renal failure and myocardial infarction: a prognostic marker?

Argentinian Registry of Acute Myocardial Infarction SAC-FAC

Abstract

Renal insufficiency is a poor prognostic factor in ST elevation Myocardial Infarction (STEMI). Objective: To evaluate the prevalence of renal dysfunction (RD) and determine its prognostic role in STEMI. Material and methods: Analysis of a prospective, observational registry, performed in 247 Argentinean centers, including patients with STEMI, between March and December, 2015. In 1402 cases, creatinine clearance (CrCl) was calculated (Cockcroft-Gault equation) in admission. Results: According with CrCl, the population was divided into groups: I (≤29 ml/min/1.73 m2): 4.2% (N=59), II (30-39 ml /min/1.73m2): 15.5% (N=217) and III (≥ 60 ml/min/1.73 m2):
80.3% (N=1126). Patients with greater RD were older, more frequently women, with higher prevalence of smoking, hypertension, previous history of myocardial infarction and heart failure (all p<0.001). Reperfusion therapy was similar; however, groups I and II received more thrombolytics and less primary angioplasty than group III, with less use of antiplatelet drugs, ACE inhibitors, beta blockers and statins. In-hospital complications were significantly higher in groups I and II than III, with a mortality of 18.6; 20.7 and 3.8%, respectively (p<0.001). Predictors of in-hospital mortality were age (OR=1.057; 95% CI=1.021-1.082), systolic blood pressure (0.987; 0.978-0.995), Killip-Kimball ≥2 (12.42; 6.31-24.45), glycemia (1.004; 1.001-1.007) and CrCl groups: I (2.82;0.99-7.95), and II (2.54; 1.27-5.07). CrCl ≤ 59 ml/min/1.73 m2 was associated with a mortality risk of 2.6 (1.3-5.0). Conclusions: One out five patients with STEMI was admitted with RD and it was a determinant of in-hospital mortality. Its early detection requires and optimization of therapeutic strategies.