Published online before print November 24, 2003, doi: 10.1161/01.CIR.0000103623.63687.21
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(Circulation. 2003;108:2769.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction
From William Beaumont Hospital, Royal Oak, Mich (H.M.S., C.L.G., S.R.D.); the Cardiovascular Research Foundation, New York, NY (G.W.S., R.M., A.J.L., M.F.); Mid Carolina Cardiology, Charlotte, NC (D.A.C.); Hospital Gregorio Maranon, Madrid, Spain (E.G.); Duke Clinical Research Institute, Durham, NC (J.E.T.); Virginia Beach General Hospital, Virginia Beach, Va (J.J.G.); Moses Cone Memorial Hospital, Greensboro, NC (T.D.S.); Center for Cardiac and Vascular Research, Tacoma Park, Md (M.T.); and the University of Colorado Health Sciences Center, Denver (J.D.C.).
Correspondence to Gregg W. Stone, MD, The Cardiovascular Research Foundation, 55 E 59th St, 6th Floor, New York, NY 10022. E-mail gstone{at}crf.org
Received April 4, 2003; de novo received July 3, 2003; revision received September 11, 2003; accepted September 12, 2003.
Background— The prognostic importance of renal insufficiency (RI) in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) has not been well characterized.
Methods and Results— PCI was performed in 2082 AMI patients without shock presenting within 12 hours of symptom onset in a prospective, multicenter randomized trial. RI was defined as a calculated (Cockroft-Gault) creatinine clearance (CrCl) 
60 mL/min. RI at baseline was present in 18% of patients. Compared with patients without RI, patients with RI were older and were more likely to be female; to have hypertension, peripheral vascular disease, or cerebrovascular disease; and to present in heart failure. Mortality was markedly increased in patients with versus without baseline RI both at 30 days (7.5% versus 0.8%, P<0.0001) and at 1 year (12.7% versus 2.4%, P<0.0001). Mortality rates increased incrementally for every 10-mL/min decrease in baseline CrCl. By multivariate analysis, reduced baseline CrCl was a powerful independent predictor of 30-day mortality (hazard ratio, 5.77; P<0.0001) and remained associated with reduced survival at 1 year (hazard ratio, 1.98; P=0.08). Hemorrhagic complications and transfusion requirements were also increased more than 2-fold in patients with RI, as were severe restenosis (diameter stenosis 
70%; 20.6% versus 11.8%, P=0.024) and infarct artery reocclusion (14.7% versus 7.3%, P=0.02).
Conclusions— Baseline RI in patients with AMI undergoing primary PCI is associated with a markedly increased risk of mortality, as well as bleeding and restenosis. Novel approaches are needed to improve the otherwise poor prognosis of patients with RI and AMI.
Key Words: angioplasty • myocardial infarction • kidney
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