Abstract 17296: The Incidence and Clinical Predictors of Persistent Renal Dysfunction in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention: Results from the Korea Working Group on Myocardial Infarction
Background: The risk of contrast-induced nephropathy may be higher in patients with acute myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI) because of hemodynamic instability, impaired systemic perfusion caused by cardiac dysfunction. We aimed to determine the incidence and clinical predictors of persistent renal dysfunction (PRD) in these patients.
Methods and Results: We included 3,606 patients from the Korea Working Group on Myocardial Infarction, who had estimated glomerular ﬁltration rate (eGFR) at baseline and one-month after PCI. ST-segment elevation MI was diagnosed in 2,025 (56.2%) patients. PRD was defined as more than moderate reduction in eGFR (<60 mL/min/1.73 m2) at one-month after PCI. PRD was observed in 2,273 (63.0%) patients. Compared to patients with normal or mild reduction in eGFR (≥60 mL/min/1.73 m2), patients with PRD were older, more likely to be female, and had more hypertension. PRD group had lower baseline eGFR (79.4 vs 56.3 mL/min/1.73 m2, p<0.001) and exhibited higher incidence of Killip class III/IV, multivessel disease, non-ST-segment elevation MI, lower cardiac function, simultaneous and multivessel PCI, and procedural complications. By multivariable analysis, old age (OR 5.3, 95% CI 4.4-6.3, p<0.001), BMI (OR 0.8, 95% CI 0.8-0.9, p<0.001), extent of coronary disease (OR 1.1, 95% CI 1.0-1.2, p=0.049), Killip class (OR 1.1, 95% CI 1.0-1.3, p=0.019), hypertension (OR 1.2, 95% CI 1.0-1.4, p=0.037) were the predictors of PRD after adjusting baseline eGFR. The rate of death, MI, or revascularization at one-year was higher in PRD group (5.6% vs 8.8%, log rank, p<0.001). The PRD was proved as an independent predictor of death, MI, or revascularization at one-year (HR 1.6, 95% CI 1.2-2.2, p=0.003).
Conclusion: In patients with acute MI who underwent PCI, PRD is more common and independent predictors are old age, BMI, extent of coronary disease, Killip class, and hypertension as well as baseline eGFR.
- © 2012 by American Heart Association, Inc.