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Renal dysfunction in ST-elevation myocardial infarction: risk factors; effect on prognosis

Karetnikova V.N.1, Evseeva M.V.1, Kalaeva V.V.2, Gruzdeva O.V.2, Kashtalap V.V.2, Shafranskaya K.S.2, Zykov M.V.2, Barbarash O.L.2
1 – State Budgetary Educational Institution of Higher Professional Education “Kemerovo State Medical Academy” of the RF Ministry of Health Care, Voroshilova 22a, Kemerovo 650029
2 – Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases” at the Siberian Branch of the Russian Academy of Medical Sciences, Sosnovy Bulvar 6, Kemerovo 650002

Keywords: ST-segment elevation myocardial infarction, renal dysfunction, prognosis

DOI: 10.18087/rhj.2014.6.2010

Background. Health care providers often disregard transient renal dysfunction (RD), the role of which in MI prognosis has been extensively discussed. On the other hand, the issue of impaired renal function results in less rational approach to secondary prevention in this group of patients. Evaluation of risk factors (RFs) for development of RD is particularly important for both prevention of these disorders and prediction of unfavorable cardiovascular outcomes in patients with MI. Aim. To determine RFs for development of RD and the effect of RD on in-hospital and remote (one and two years) prognosis in patients with ST-elevation MI (STEMI). Materials and methods. Participants of this registry study were 954 patients with ST-elevation acute coronary syndrome (ACS), including 620 (65 %) men. Mean age of the general sample was 63.4 (62.6–64.2). To calculate the glomerular filtration rate (GFR), the MDRD formula was used, which took into account the serum creatinine level measured on admission. Results. Based on GFR values, all patients were divided into two groups, with (n=351; 36.8 %) and without RD (n=603; 63.2 %). RD was defined as a decrease in GFR to lower than 60 ml / min / 1.73 m2. Monofactorial analysis showed that the presence of RD in the acute STEMI phase 3.3 times increased the risk for fatal outcome within the next year and 2.5 times within the next three years. The presence of DM increased the probability for RD 1.7 times, chronic kidney disease (CKD), arterial hypertension (AH), and Killip class II–IV acute HF (AHF) – 2.1–2.2 times; and multifocal atherosclerosis (MFA) – 4 times. Multifactorial logistic regression analysis determined a set of predictors influencing the development of RD: ageing by one year increased the probability of RD by 6.2 %; probability of MI-associated RD was lower for men than for women; and a higher Killip class of AHF increased the chance for RD 1.9 times. Conclusion. RD detected in the acute phase of STEMI influences the incidence of adverse outcomes in inpatient and remote (one and three years) postinfarction phases. Women older that 60 with Killip class II–IV AHF are at higher risk of RD in STEMI.
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Karetnikova V. N., Evseeva M. V., Kalaeva V. V. et al. Renal dysfunction in ST-elevation myocardial infarction: risk factors; effect on prognosis. Russian Heart Journal. 2014;13 (6):339–346.

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