TY - JOUR
T1 - Impact of cardiac and renal dysfunction on inhospital morbidity and mortality of patients with acute myocardial infarction undergoing primary angioplasty
AU - Marenzi, Giancarlo
AU - Moltrasio, Marco
AU - Assanelli, Emilio
AU - Lauri, Gianfranco
AU - Marana, Ivana
AU - Grazi, Marco
AU - Rubino, Mara
AU - De Metrio, Monica
AU - Veglia, Fabrizio
AU - Bartorelli, Antonio L.
PY - 2007/5
Y1 - 2007/5
N2 - Background: Risk stratification of patients with ST-elevation myocardial infarction (STEMI) undergoing primary angioplasty is important in order to predict outcomes and to delineate targeted therapeutic strategies. Although the prognostic implications of reduced left ventricular ejection fraction (LVEF) and creatinine clearance (CrCl) have been recognized, the clinical and prognostic impact of their combination has never been prospectively evaluated. Methods: We stratified 467 patients with STEMI undergoing primary angioplasty according to LVEF and CrCl values at admission: CrCl >60 mL/min and LVEF >40% (group 1, n = 261); CrCl ≤60 mL/min and LVEF >40% (group 2, n = 113); CrCl >60 mL/min and LVEF ≤40% (group 3, n = 60); CrCl ≤ 60 mL/min and LVEF ≤40% (group 4, n = 33). Results: Inhospital mortality was different in the 4 groups (1% in group 1, 3% in group 2, 15% in group 3, 30% in group 4) (P <.001). The incidence of combined end point of death, acute pulmonary edema, cardiogenic shock, and acute renal failure requiring mechanical support increased progressively from group 1 to group 4 (5%, 17%, 33%, and 48%, respectively) (P <.001). We found a significant gradient of risk in terms of inhospital mortality and combined end point when patients outcome was evaluated according to the presence of both normal LVEF and CrCl (group 1), impairment in only 1 of these 2 parameters (group 2 and 3 pooled together), and combined LVEF and CrCl reductions (group 4). Conclusions: Reduced LVEF and CrCl are strong independent predictors of increased inhospital morbidity and mortality, and their combined evaluation provides a simple tool for early risk stratification in patients with STEMI treated with primary angioplasty.
AB - Background: Risk stratification of patients with ST-elevation myocardial infarction (STEMI) undergoing primary angioplasty is important in order to predict outcomes and to delineate targeted therapeutic strategies. Although the prognostic implications of reduced left ventricular ejection fraction (LVEF) and creatinine clearance (CrCl) have been recognized, the clinical and prognostic impact of their combination has never been prospectively evaluated. Methods: We stratified 467 patients with STEMI undergoing primary angioplasty according to LVEF and CrCl values at admission: CrCl >60 mL/min and LVEF >40% (group 1, n = 261); CrCl ≤60 mL/min and LVEF >40% (group 2, n = 113); CrCl >60 mL/min and LVEF ≤40% (group 3, n = 60); CrCl ≤ 60 mL/min and LVEF ≤40% (group 4, n = 33). Results: Inhospital mortality was different in the 4 groups (1% in group 1, 3% in group 2, 15% in group 3, 30% in group 4) (P <.001). The incidence of combined end point of death, acute pulmonary edema, cardiogenic shock, and acute renal failure requiring mechanical support increased progressively from group 1 to group 4 (5%, 17%, 33%, and 48%, respectively) (P <.001). We found a significant gradient of risk in terms of inhospital mortality and combined end point when patients outcome was evaluated according to the presence of both normal LVEF and CrCl (group 1), impairment in only 1 of these 2 parameters (group 2 and 3 pooled together), and combined LVEF and CrCl reductions (group 4). Conclusions: Reduced LVEF and CrCl are strong independent predictors of increased inhospital morbidity and mortality, and their combined evaluation provides a simple tool for early risk stratification in patients with STEMI treated with primary angioplasty.
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U2 - 10.1016/j.ahj.2007.02.018
DO - 10.1016/j.ahj.2007.02.018
M3 - Article
C2 - 17452149
AN - SCOPUS:34247101480
VL - 153
SP - 755
EP - 762
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
IS - 5
ER -