Does Kidney Function Alter the Benefit of Reperfusion Therapy for ST-Segment Elevation Myocardial Infarction?

In the last decade, the importance of chronic kidney disease (CKD) as a cardiovascular risk factor has become clear. The graded risk of CKD is present at all levels of renal function and is a risk factor in those with unrecognized cardiovascular disease or stable coronary disease or after a percutaneous coronary intervention (PCI) or myocardial infarction (1,2). In patients presenting with a myocardial infarction, mild CKD is associated with a 3-fold increase in mortality (1). This risk increases progressively with declining renal function, to a maximum mortality risk in patients with end-stage renal disease (ESRD) that is 15 times higher than in patients with normal renal function. This finding has been substantiated by similar findings in multiple studies, confirming that renal disease is a strong correlate of both early and late mortality (3-7).