2013


To access this material please log in or register

Register Authorize
2013/№5

Significance of renal dysfunction for in-hospital prognosis in patients with ST elevation myocardial infarction

Karetnikova V. N., Zykov M. V., Kashtalap V. V., Bykova I. S., Shafranskaya K. S., Evseeva M. V., Kalaeva V. V., Chesnokova L. Yu., Barbarash O. L.

Keywords: myocardial infarction, renal dysfunction, prognosis

DOI: 10.18087/rhj.2013.5.1846

Background. The incidence of impaired renal function in MI is 25–30 % and it can result from the action of many factors. However at the present time, strong data on the effect of renal dysfunction (RD) on the course of IM during the period of inpatient care are not available. Aim. In a registry study, evaluating the RD incidence and its effect on outcomes of the inpatient treatment in patients with ST elevation MI. Materials and methods. The study included 954 patients with ST elevation MI (STeMI). Glomerular filtration rate (GFR) was computed using the MDRD equation. In the period of hospital care, manifestations of coronary insufficiency, severity of acute HF (AHF), and in-hospital mortality rate were evaluated. Results. RD was diagnosed in 36.8 % of patients with STeMI. The presence of RD was associated with older age, female gender, aggravated cardiovascular history, and more severe manifestations of AHF according to Killip classification. Also, patients of this group significantly less frequently underwent transcutaneous coronary interventions (TCI) and had higher in-hospital mortality rate. The study demonstrated the significance of RD as an independent predictor of fatal outcome in patients with STeMI. Conclusion. RD (GFR<60 ml / min / 1.73 m2) was detected in 36.8 % of patients with STeMI. Impaired renal function is associated with underlying diseases (for IHD) such as AH, DM, and CHF and significantly influences the in-hospital mortality rate.
  1. Szummer K, Lundman P, Jacobson SH et al. Influence of renal function on the effects of early revascularization in non-ST-elevation myocardial infarction: data from the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART). Circulation. 2009;120 (10):851–858.
  2. Verma S, Gupta M, Holmes DT et al. Plasma renin activity predicts cardiovascular mortality in the Heart Outcomes Prevention Evaluation (HOPE) study. Eur Heart J. 2011;32 (17):2135–2142.
  3. Thurston RC, Sutton-Tyrrell K, Everson-Rose SA et al. Hot flashes and subclinical cardiovascular disease: findings from the Study of Women's Health Across the Nation Heart Study. Circulation. 2008;118 (12):1234–1240.
  4. Collins AJ, Li S, Gilbertson DT et al. Chronic kidney disease and cardiovascular disease in the Medicare population. Kidney Int Suppl. 2003; (87):S24–31.
  5. Johnston N, Dargie H, Jardine A. Diagnosis and treatment of co­ronary artery disease in patients with chronic kidney disease: Ischaemic heart disease. Heart. 2008;94 (8):1080–1088.
  6. Herzog CA, Littrell K, Arko C et al. Clinical characteristics of dialysis patients with acute myocardial infarction in the United States: a collaborative project of the United States Renal Data System and the National Registry of Myocardial Infarction. Circulation. 2007;116 (13):1465–1472
  7. Wright RS, Reeder GS, Herzog CA et al. Acute myocardial infarction and renal dysfunction: a high-risk combination. Ann Intern Med. 2002;137 (7):563–570.
  8. Levey AS, Stevens LA, Schmid CH et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150 (9):604–612.
  9. Santopinto JJ, Fox KAA, Goldberg RJ et al. Creatinine clearance and adverse hospital outcomes in patients with acute coronary syndromes: findings from the global registry of acute coronary events (GRACE). Heart. 2003;89 (9):1003–1008.
  10. Sorensen CR, Brendorp B, Rask-Madsen et al. The prognostic importance of creatinine clearance after acute myocardial infarction. Eur Heart J. 2002;23 (12):948–952.
  11. Shlipak MG, Heidenreich PA, Noguchi H et al. Association of renal insufficiency with treatment and outcomes after myocardial infarction in elderly patients. Ann Intern Med. 2002;137 (7):555–562.
  12. Wright RS, Reeder GS, Herzog CA et al. Acute myocardial infarction and renal dysfunction: a high-risk combination. Ann Intern Med. 2002;137 (7):563–570.
Karetnikova V.N., Zykov M.V., Kashtalap V.V. et al. Significance of renal dysfunction for in-hospital prognosis in patients with ST elevation myocardial infarction. Russian Heart Journal. 2013;12(5):299-304

To access this material please log in or register

Register Authorize
Ru En