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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Chin+Med+J+(Engl)
2015 ; 128
(1
): 1-6
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A multicentre prospective evaluation of the impact of renal insufficiency on
in-hospital and long-term mortality of patients with acute ST-elevation
myocardial infarction
#MMPMID25563305
Li C
; Hu D
; Shi X
; Li L
; Yang J
; Song L
; Ma C
Chin Med J (Engl)
2015[Jan]; 128
(1
): 1-6
PMID25563305
show ga
BACKGROUND: Numerous previous studies have shown that renal insufficiency (RI) in
patients with acute coronary syndrome is associated with poor cardiovascular
outcomes. These studies do not well address the impact of RI on the long-term
outcome of patients with acute ST-elevation myocardial infarction (STEMI) in
China. The aim of this study was to investigate the association of admission RI
and inhospital and long-term mortality of patients with acute STEMI. METHODS:
This was a multicenter, observational, prospective-cohort study. 718 consecutive
patients were admitted to 19 hospitals in Beijing within 24 hours of onset of
STEMI, between January 1,2006 and December 31,2006. Estimation of glomerular
filtration rate (eGFR) was calculated using the modified abbreviated modification
of diet in renal disease equation-based on the Chinese chronic kidney disease
patients. The patients were categorized according to eGFR, as normal renal
dysfunction (eGFR ? 90 ml·min -1·1.73 m -2 ), mild RI (60 ml·min -1·1.73 m -2 ?
eGFR < 90 ml·min -1·1.73 m -2 ) and moderate or severe RI (eGFR < 60 ml·min
-1·1.73 m -2 ). The association between RI and inhospital and 6-year mortality of
was evaluated. RESULTS: Seven hundred and eighteen patients with STEMI were
evaluated. There were 551 men and 167 women with a mean age of 61.0 ± 13.0 years.
Two hundred and eighty patients (39.0%) had RI, in which 61 patients (8.5%)
reached the level of moderate or severe RI. Patients with RI were more often
female, elderly, hypertensive, and more patients had heart failure and stroke
with higher killip class. Patients with RI were less likely to present with chest
pain. The inhospital mortality (1.4% vs. 5.9% vs. 22.9%, P < 0.001), 6-year
all-cause mortality (9.5% vs. 19.8 vs. 45.2%, P < 0.001) and 6-year cardiac
mortality (2.9% vs. 12.2% vs. 23.8%, P < 0.001) were markedly increased in
patients with RI. After adjusting for other confounding factors, classification
of admission renal function was an independent predictor of inhospital mortality
(Odd ratio, 1.966; 95% confidence interval [CI], 1.002-3.070, P = 0.019), 6-year
all-cause mortality (relative risk [RR] = 1.501, 95% CI: 1.018-4.373, P = 0.039)
and 6-year cardiac mortality (RR = 1.663, 95% CI: 1.122-4.617, P = 0.042).
CONCLUSIONS: RI is very common in STEMI patients. RI evaluated by eGFR is an
important independent predictor of short-term and long-term outcome in patients
with acute STEMI.