Elevated admission serum creatinine predicts poor myocardial blood flow and one-year mortality in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

BACKGROUND: Outcomes after percutaneous coronary intervention (PCI) for patients with acute myocardial infarction (AMI) complicated by renal insufficiency have been well described. However, data regarding admission serum creatinine and coronary and myocardial flow are scant. The aims of this study are to evaluate the effects of admission serum creatinine on coronary blood flow and prognosis in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary PCI.

METHODS: A total of 495 patients undergoing primary PCI for STEMI within 12 hours after symptom onset were studied. Patients were divided into two groups according to admission serum creatinine level: 1) elevated serum creatinine group (elevated group, serum creatinine > or = 1.3 mg/dl), and 2) normal serum creatinine group (normal group, serum creatinine < 1.3 mg/dl).

RESULTS: Elevated serum creatinine was observed in 86 patients. Univariate analyses showed statistical differences between normal and elevated serum creatinine groups in age, gender, number of diseased vessels, hypertension, previous MI, serum creatinine level and Killip's grades on presentation. Corrected TIMI frame count (CTFC) in the elevated group was more than in the normal group, and TIMI myocardial perfusion grades (TMPG) 0-1 were more frequent (5.6% and 12.8%, p < 0.05). Elevated admission serum creatinine was an independent predictor of poor myocardial perfusion (adjusted relative risk [RR] 3.93; 95% confidence interval [CI] 1.13-6.84) and a higher rate of 1-year mortality in STEMI patients undergoing primary PCI (adjusted RR 1.41; 95% CI 1.24-2.69]).

CONCLUSIONS: The elevated admission serum creatinine levels are associated with impaired myocardial flow and poor prognosis in STEMI patients undergoing primary PCI.