Evolução da função renal na fase aguda do infarto do miocárdio como fator prognóstico de eventos na fase intra-hospitalar e em um ano de seguimento

Abstract

M a i l i n g A d d r e s s : E d u a r d o P i m e n t a OBJECTIVETo analyze the role of renal dysfunction at admission or during hospitalization in patients with acute myocardial infarction (AMI). METHODSTwo hundred and seventy-four patients with AMI were assessed between January 2000 and December 2001. Renal function was monitored by serum creatinine (Cr) measurement at admission and peak level during hospitalization. Creatinine clearance (CrCl) was estimated by the Cockcroft-Gault formula. In-hospital and one-year morbidity and mortality were evaluated. RESULTSMean age of the population studied was 62.2 ± 13.5, and 73% of the patients were male. Renal function was more reduced in male patients and in those with systemic arterial hypertension and prior CABG. Multivariate analysis showed higher hospital mortality rates associated with increased peak serum Cr levels (OR: 1.18 95% CI:1.18-2.77 p = 0.006), decreased baseline CrCl (OR:0.96 95% CI:0.93-0.99 p = 0.025) and peak CrCl (OR:0.96 95% CI:0.92-0.99 p = 0.023). Percent difference between baseline CrCl and the lowest CrCl obtained during hospitalization also indicated higher mortality rates (OR: 1.04 95% CI: 1.00-1.07 p = 0.033). No change was observed in the one-year morbidity and mortality from worsening of renal function. CONCLUSIONRenal dysfunction at admission and its deterioration during hospitalization have proved to be a major prognostic marker for immediate poor outcome. KEY WORDSAcute myocardial infarction, renal insufficiency, cardiovascular diseases.

Insuficiência renal oculta acarreta risco elevado de mortalidade após cirurgia de revascularização miocárdica

“…Among our patients, group B, with an average of CrCl 51.4 mL/min, and group C with 34.8 mL/min, showed a RR of 2.1 (95% CI: 1.5 to 2.8 ) and 4.18 (95% CI: 2.9 to 6.1) compared to group A (mean CrCl = 80.2 mL/min). Pimenta et al [5] in a retrospective analysis of inhospital outcome of renal function in 274 patients, also demonstrated a higher rate of mortality among those with lower values †of CrCl.…”

“…Kidney failure is one of the most important risk factors for complications after both acute ischemic cardiac events [1][2][3][4] and in cardiac surgery, causing longer hospital stays and higher in-hospital mortality [5,6]. In coronary artery bypass grafting (CABG), the previous presence of renal dysfunction is an independent predictor of operative mortality [5.7 to 12].…”

“…However, this method requires an extended period of time for obtaining the urine and is also subject to errors such as those arising from incomplete collection of urine in the period. Thus, some equations were developed to estimate creatinine clearance using only the values †of PCr, body weight, age and gender [5,13,[16][17][18][19][20]. Because of its simplicity, one of the most widely used equations is that proposed by Cockcroft & Gault (CG) [21].…”