Prognostic Value of Kidney Function in Patients With ST-Elevation and Non-ST-Elevation Acute Myocardial Infarction Treated With Percutaneous Coronary Intervention

Background: Patients with decreased kidney function and acute ST-elevation myocardial infarction (STEMI) and non-STEMI are less likely to receive reperfusion therapy and aggressive medical treatment. This undertreatment may contribute to the poor outcome of these patients. The prognostic value of kidney function in patients with STEMI and NSTEMI treated predominantly with percutaneous coronary intervention (PCI) and aggressive medical treatment is less known. Study Design: Prospective cohort study. Setting & Participants: 2 academic centers in Germany; 4,701 consecutive patients with acute myocardial infarction (AMI) from 1998 to 2006. Predictor: Estimated creatinine clearance (eCCr) at admission. Outcomes & Measurements: The primary end point was all-cause mortality during the first year after PCI for AMI (STEMI and NSTEMI) with a prespecified landmark at 30 days (landmark analysis). Secondary end points were nonfatal myocardial infarction, stroke, and major bleeding. Results: Patients were divided into quartiles according to eCCr less than 56, 56 to 76, 77 to 100, and greater than 100 mL/min. Patients had an increased risk of death with decreased eCCr both within 30 days (7.7%, 3.1%, 1.4%, and 0.7% for the 4 quartiles; P < 0.001) and after 30 days (12.1%, 4.8%, 1.9%, and 1.2%; P < 0.001). The association of eCCr with mortality was similar in patients younger and older than 70 years. Major bleeding within 30 days and incidence of stroke also were more frequent with reduced eCCr. However, recurrent myocardial infarction was not associated with eCCr. After adjustment for additional baseline characteristics, kidney function based on eCCr at admission remained a strong independent predictor of mortality at 1 year after AMI (hazard ratio, 1.21 per 10-mL/min decrease; 95% confidence interval, 1.13 to 1.30). Limitations: Single assessment of eCCr. Conclusions: In patients with AMI treated with primary PCI for STEMI and early PCI for NSTEMI, eCCr at admission remains a powerful independent predictor of short- and long-term mortality. Am J Kidney Dis 54:830-839. (C) 2009 by the National Kidney Foundation, Inc.