| ǥ :
|
ȣ - 530103 8 |
| Decreased Glomerular Filtration Rate is an Independent Predictor of In-hospital Mortality in Patients with ST-segment Elevation Myocardial Infarction Undergoing Primary Angioplasty |
| 대한심장학회 Korea Acute Myocardial Infarction Registry 연구자 |
| 김준영, 정명호, 안영근, 채성철, 허승호, 성인환, 김종현, 홍택종, 구본권, 채제건, 채동훈, 윤정한, 배장호, 나승운, 류제영, 김두일, 김기식, 김병옥, 오석규, 채인호, 이명용, 정경태, 조명찬, 김종진, 김영조, 외 Korea Acute Myocardial Infarction Registry Investigators |
BACKGROUNDS: Patients with renal dysfunction have a worse prognosis after an acute myocardial infarction. Data about the impact of renal dysfunction on clinical outcomes in ST-segment elevation myocardial infarction patients who treated by primary angioplasty are not so much. Therefore, the aim of the present study was to investigate if such an association clearly exists in Korean population. METHODS: We evaluated 4812 eligible patients from the Korea Acute Myocardial Infarction Registry (KAMIR) who underwent primary PCI within 24 hours of symptom onset. Patients were divided into 3 groups according to glomerular filtration rate (GFR), calculated by the Modification of Diet in Renal Disease (MDRD) method: normal renal function group, GFR≥60 ml/min/1.73㎡ (N=3707, 2926 men, 59.9±12.4 years), moderate renal dysfunction group, GFR 30 to 59 ml/min/1.73㎡ (N=963, 550 men, 70.2±10.3 years) and severe renal dysfunction group GFR<30 ml/min/1.73㎡ (N=142, 75 men, 69.1±12.8 years). Baseline characteristics, procedural result and in-hospital outcomes were analyzed. RESULTS: Age, Sex, Killip class≥3, anterior wall infarction, hypertension, diabetes, multivessel disease, Left ventricular ejection fraction, High-sensitivity C-reactive protein, B-type natriuretic peptide levels were significantly different between 3 groups (p<0.05). As renal function declined, rate of unsuccessful PCI (TIMI<3) was increased (7.1% vs. 13.3% vs. 13.8%, p<0.0001) and in-hospital complication rates including arrhythmia, cardiogenic shock, major bleeding, acute renal failure were increased (13.9% vs. 32.3% vs. 43.3%, p<0.0001). In-hospital mortality rate was also increased according to their renal function (2.4% vs. 15.4% vs. 24.6%, p<0.0001). On multiple logistic regression analysis, odds ratios for in-hospital mortality were 3.06 in the moderate renal dysfunction group, 6.41 in the severe renal dysfunction group compared with the normal renal function group (p<0.0001). CONCLUSIONS: Decreased GFR was associated with the risk of unsuccessful PCI, in-hospital complications and independent predictor of in-hospital mortality in AMI patients.
|
|
|
|
|
