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| Safety and long term clinical outcomes of early percutaneous coronary intervention in acute non ST elevation myocardial infarction patients with renal insufficiency |
| 전남대학교병원¹ ,동아대학교병원² , 동산의료원³ ,충남대학병원⁴ ,동서신의학병원5 |
| 고점석¹, 김영대² , 김윤년³ , 성인환⁴, 조진만 5 , 정명호¹ ,Korea Working Group on Myocardial Infarction Investigators |
Introduction : Early invasive strategy was established approach for management of acute myocardial infarction. But one of the common obstacles to this strategy was combined renal insufficiency at presentation. We aimed to evaluate the safety and clinical outcomes of early percutaneous coronary intervention(PCI) for acute non ST elevation myocardial infarction(NSTEMI) patients with renal insufficiency.
Methods : We analyzed 321 patients (male 70.4%, Age 69±9.3 yr) who were presented with NSTEMI and profound renal insufficiency defined as less than 60 mL/min/1.73m2 of creatinine clearance from KORMI(Korea Working Group of Myocardial Infarction) data. We checked baseline characteristics, laboratory, echocardiographic and angiographic findings. We divided patients into two groups according to door to PCI time. In hospital mortality and clinical outcomes during 1 month follow up were assessed.
Results : According to door to PCI time, 134 patients underwent PCI within 24hr(41.7%, early PCI group) and 187 patients underwent PCI after 24hr(58.3%, late PCI group). There was no significant difference in baseline characteristics except incidence of DM(38.8% in early PCI group, 57.2% in late PCI group). In laboratory data, early PCI group had higher value of CK-MB(98.1±176.5 vs 37.7±66.6, p<0.001), troponin I(37±86.8 vs 18.5±43.4, p=0.021) and lower value of NT pro-BNP(7235.6±10622.4 vs 11119.9±12449.8, p=0.031). There was no significant difference in echocardiographic and angiographic result. In-hospital death occurred in 18 patients(5.6%) and no significant difference between groups(6.8% in early PCI group vs 4.8% in late PCI group, p=0.470). During 1 month follow up, death/myocardial infarction was occured in 4 patients(2.3%) and MACE was developed in 5 patients(2.8%) and no significant difference between groups.
Conclusion : The early PCI for NSTEMI patient with profound renal insufficiency was safety strategy and showed acceptable short term clinical outcome compared with late PCI. To evaluate long term clinical outcomes, more prolonged clinical follow up is needed.
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