The Prognostic Impact of Renal Failure in Patients with ST-Segment Elevation Ac...

• Author(s): Timóteo, AT ; Fiarresga, A ; Feliciano, J ; Pelicano, NJ ; Ferreira, ML ; Cruz Ferreira, R ; Serra, J ; Oliveira, JA ; Quininha, J
• Date: 2005
• Persistent ID: http://hdl.handle.net/10400.17/37
• Origin: Repositório do Centro Hospitalar de Lisboa Central, EPE
• Subject(s): Adulto; Idoso; Comorbidade; Intervalos de Confiança; Creatinina; Electrocardiografia; Sistema de Condução Cardíaco; Falência Renal Crónica; Enfarte do Miocárdio; Razão de Possibilidades; Prognóstico; Estudos Retrospectivos; Análise de Sobrevivência; HSM CAR
• Document Type: Article
• Language: English

Description

INTRODUCTION: Renal insufficiency (RI) is associated with higher morbidity and mortality in patients (P) with coronary artery disease and in P submitted to angioplasty. In ST-segment elevation acute myocardial infarction (STEAMI), this impact has not been well demonstrated. AIM: To evaluate the impact of RI in P with STEAMI. METHODS: We evaluated 160 P admitted with STEAMI, mean age of 62+/-14 years, 76% male. We determined creatinine levels on admission. RI was defined as a level >1.5 mg/dl. Analysis of clinical, electrocardiographic and laboratory variables was performed, in relation to the endpoint defined as the occurrence of death at 30-day follow-up. RESULTS: There were 16 deaths (10%) at 30-day follow-up. P with RI (n=21) were older (68+/-11 vs 61+/-14 years, p<0.001), more often had diabetes (57 vs 24 %, p=0.004) and presented more often with Killip class > or =2 (57 vs 12%, p<0.001). The use of statins (62 vs 83%, p=0.05) and beta-blockers (24 vs 65%, p<0.001) was lower in P with RI. Mortality was higher in RI P (62 vs 2%, p<0.001). The univariate predictors of death were age > or =75 years, diabetes, Killip class > or =2 on admission, RI, non-use of statins and beta-blockers and use of diuretics. In multivariate analysis, independent predictors of death at 30 days were RI (HR 29.6, 95% CI 6.3-139.9, p<0.001) and non-use of beta-blockers (HR 0.13, 95% CI 0.02-1.01, p=0.01). CONCLUSION: In P admitted for STEAMI, the presence of RI was an independent predictor of death at 30 days whereas the usage of beta-blockers was protective.