Abstract 4198: Microvascular Damage in Patients With Severe Renal Dysfunction After Successful Primary Angioplasty for Acute Myocardial Infarction
Background; Renal dysfunction is associated with poor outcomes after reperfused acute myocardial infarction (AMI). However, little information is available about relation of renal dysfunction with microvascular damage after reperfusion.
Object; The aim of this study was to determine the relationship of renal dysfunction and myocardial microvascular damage after successful primary angioplasty by intravenous myocardial contrast echocardiography(MCE) -currently the best accurate measure of reperfusion at a microvascular level.
Method; We studied 283 consecutive patient (mean age 64.3±11.9years, 217males) with successful primary angioplasty for anterior AMI. Glomerular filtration rate(GFR) was estimated by Modification of diet in renal desease (MDRD) study formula using serum creatinine level on admission. Severe renal dysfunction was defined as estimated GFR<30ml/min/1.73m2. We performed intravenous MCE two weeks later from primary angioplasty and calculated contrast defect area.
Result; 191(67.5%) patients had GFR>60ml/min/1.73m2, 83(29.3%) patients had GFR>30 –59ml/min/1.73m2, 8(2.8%) patients had GFR<30ml/min/1.73m2(severe renal dysfunction); 4(1.4%) patients had GFR>15–30ml/min/1.73m2, 4(1.4%) patients had GFR<15ml/min/1.73m2. Patients with severe renal dysfunction were older and with no significant gender difference. Two weeks later MCE showed greater contrast defect area in patients with severe renal dysfunction (%defect area; 19.8±11.8% vs. 13.6±8.7%, p<0.05). Severe renal dysfunction was associated with higher serum C-reactive protein(CRP) levels (5.6±5.1mg/dl vs.0.7±1.7 mg/dl, p<0.001) and lower Left ventricular(LV) ejection fraction(46.4±15.1% vs.55.2±12.0 %, p<0.001).
Conclusion; Severe renal dysfunction was associated with greater myocardial microvascular damage after successful primary angioplasty for anterior AMI.