Turk Kardiyol Dern Ars. 2011; 39(4): 276-282 | DOI: 10.5543/tkda.2011.01467

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

Emre Akkaya¹, Erkan Ayhan³, Hüseyin Uyarel², Mehmet Ergelen², Ayça Türer¹, Deniz Demirci¹, Duygu Demirci¹, Gökhan Çiçek¹, Mehmet Gül¹, Zeki Günaydın¹, Ahmet Narin^1
1Dr. Siyami Ersek Thoracic And Cardiovascular Surgery Center, Training And Research Hospital, Cardiology Department, Istanbul, Turkey
²Balıkesir University Medical School of Medicine, Cardiology Department, Balikesir, Turkey
³Bismil State Hospital, Diyarbakir

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.

Keywords: Angioplasty, balloon, coronary, creatinine; glomerular filtration rate; hospital mortality; kidney failure, chronic; myocardial infarction/mortality; risk factors

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