ORIGINAL ARTICLE   

Minerva Cardioangiologica 2018 February;66(1):6-15

DOI: 10.23736/S0026-4725.17.04506-6

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Impact of chronic kidney disease on mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. A long-term single-center mortality study

Mattia PEYRACCHIA ✉, Paolo SCACCIATELLA, Federico CONROTTO, Ilaria MEYNET, Lorenza M. BIAVA, Carlo BUDANO, Mauro PENNONE, Maurizio D’AMICO, Fiorenzo GAITA

Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino, Turin, Italy

BACKGROUND: Chronic kidney disease (CKD) is associated with increased risk of mortality. We examined the impact of moderate and severe CKD at presentation on short- and long-term mortality among unselected patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI).
METHODS: The study cohort consists of 501 patients (pts), enrolled from October 2005 to December 2012. The median follow-up was 46.52±25.58 months (range 8-99). A severe CKD (estimated Glomerular Filtration Rate [eGFR] <30 mL/min/1.73 m2) was detected in 16 pts (3.19%), a moderate CKD (eGFR 30-59 mL/min/1.73 m2) in 110 (21.96%) and a normal kidney function (eGFR >60 mL/min/1.73 m2) in 375 (74.85%).
RESULTS: The crude in-hospital mortality rate resulted significantly higher in pts with severe and moderate CKD compared to pts with normal renal function (50% and 19.08% versus 2.93%, P<0.0001), as well as the long-term mortality rate (57.14% and 46.34% versus 8.77%, P<0.0001). After adjustment for confounding variables, severe and moderate CKD resulted the main independent predictors of in-hospital (odds ratio [OR]=21.815, P<0.0001 for severe CKD and OR= 4.203, P=0.002 for moderate CKD) and long-term (hazard ratio [HR]= 5.272, P=0.001; HR= 1.978, P=0.006) mortality.
CONCLUSIONS: CKD is a frequent condition in patients with STEMI treated with PPCI and it is associated to an excess of mortality, resulting the main independent negative prognostic predictor.

KEY WORDS: Renal insufficiency, chronic - Angioplasty- Myocardial infarction - Mortality