ORIGINAL ARTICLE The prognostic impact of renal failure in patients with ST-segment elevation acute myocardial infarction

Abstract

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 ≥2 (57 vs 12%, p<0.001). The use of statins (62 vs 83%, p=0.05) and β-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 ≥75 years, diabetes, Killip class ≥2 on admission, RI, non-use of statins and β-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 β-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 β-blockers was protective.