Abstract 11844: Optimal Therapeutic Management Improves Long-Term Survival in ST-Elevation Myocardial Patients With Altered Glomerular Filtration Rate. A Propensity Score Comparison
Introduction: Patients with chronic kidney disease have more comorbidities and will receive fewer evidence-based therapies.
Hypothesis: In a prospective ST-elevated myocardial infarction (STEMI) patient cohort we assessed the effect of an optimal therapeutic management (OTM) according to GFR categories on long-term all-cause mortality.
Methods: 1,199 patients admitted for acute STEMI were enrolled between 2007 and 2011 at our university hospital. We classified patients into 4 categories according to estimated GFR, 90 mL/min/1.73 m2 with the Chronic Kidney Disease Epidemiology Collaboration (CKD EPI) equation. Optimal therapeutic management was defined as a combination of reperfusion within 12 hours of symptom onset, primary percutaneous coronary intervention (PCI), double anti-platelet regimen, angiotensin converting enzyme inhibitors, statins, beta blockers, and anti-aldosterone treatment (if left ventricle ejection fraction <40%) upon discharge. The effect of OTM on survival according to GFR categories was analysed using a propensity score method. Long-term mortality was the principal endpoint.
Results: Patients were followed-up for a median of 4.7 years and 148(12.3%) patients died. OTM was applied in 431 (39.1%) patients of our cohort and overall, was associated with a significantly lower mortality (HR of 0.43 (95% CI, 0.26-0.70; P<0.001). The significant mortality reduction in OTM patients compared to non-OTM patients tended to increase with increasing levels of renal dysfunction (HR of 0.28 [95% CI, 0.13-0.61] in the eGFR<60 ml/min patient subgroup; P=0.001)as shown in Figure 1. (Figure 1)
Conclusion: In a propensity score analysis, OTM lowers long-term mortality whatever the eGFR category with a trend towards increased efficiency with increasing levels of renal dysfunction.
Author Disclosures: N. Mewton: None. F. Subtil: None. O. Zouaghi: None. J. Mahé: None. B. De Breyne: None. E. Bonnefoy-Cudraz: Consultant/Advisory Board; Modest; Novartis.
- © 2014 by American Heart Association, Inc.