[The impact of chronic kidney disease on in-hospital clinical outcomes in patients undergoing primary percutaneous angioplasty for ST-segment elevation myocardial infarction]

Emre Akkaya, Erkan Ayhan, Hüseyin Uyarel, Mehmet Ergelen, Ayça Türer, Deniz Demirci, Duygu Demirci, Gökhan Ciçek, Mehmet Gül, Zeki Günaydın, Ahmet Narin
Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır 2011, 39 (4): 276-82

OBJECTIVES: We investigated the effect of chronic kidney disease (CKD) on in-hospital results in patients undergoing primary percutaneous angioplasty for ST-segment elevation myocardial infarction (STEMI).

STUDY DESIGN: The study included 2,486 patients (2,070 men, 416 women) who were treated with primary angioplasty for STEMI. Of these, 273 patients (11%) were found to have CKD (glomerular filtration rate <60 ml/min/1.73 m2) before the procedure. Patients with and without CKD were evaluated with respect to demographic and clinical features, primary angioplasty findings, and in-hospital clinical results.

RESULTS: Patients with CKD exhibited a higher mean age, Killip class, and higher frequencies of female gender, diabetes, hypertension, anemia, and previous myocardial infarction (p<0.05). Angioplasty showed higher rates of right coronary artery lesion, multivessel disease, contrast nephropathy, unsuccessful procedure, and increased stenosis rate and stent length in CKD patients (p<0.05). Cardiovascular mortality occurred in 11.7% and 1.4% of patients with and without CKD, respectively (p<0.001). Patients with CKD had significantly higher incidences of target vessel revascularization, major cardiac events, stroke, cardiopulmonary resuscitation, hemodialysis, ventricular tachycardia/fibrillation, severe heart failure, cardiogenic shock, and significant hemorrhage (p<0.05). Multivariate analysis showed that CKD was an independent predictor of mortality (OR=4.1, 95% CI 1.83-9.17; p=0.001).

CONCLUSION: Our findings show that CKD patients undergoing primary angioplasty for STEMI have an increased risk profile and poorer in-hospital results, and that CKD represents an independent risk factor for mortality.

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