Renal Failure Impact on the Outcomes of ST-Segment Elevation Myocardial Infarction Patients Due to a Left Main Coronary Culprit Lesion Treated Using a Primary Percutaneous Coronary Intervention

Abstract

Background: Patients with ST-segment elevation myocardial infarction (STEMI) and primary percutaneous coronary intervention (PPCI) on a left main culprit lesion have very high mortality rates. The interaction of chronic kidney disease (CKD) with such a catastrophic acute event on the background of their highly complex atherosclerotic lesions is not well established. Therefore, we sought to evaluate in these patients the influence of the estimated glomerular filtration rate (eGFR) on short- and long-term mortality. Methods: We retrospectively analyzed renal function in 81 patients with STEMI and PPCI on a left main culprit lesion from two tertiary centers. Results: Patients were divided in two groups according to an eGFR cut-off of 60 mL/min/1.73 m2: 40 patients with CKD and 41 without CKD. Patients with renal failure were older, had more diabetes, and had experienced more frequent myocardial infarction MIs. CKD patients had a higher baseline-SYNTAX score (p = 0.015), higher residual-SYNTAX score (p < 0.001), and lower SYNTAX revascularization index-SRI (p = 0.003). Mortality at 30-day, 1-year, and 3-year follow-ups were not significantly different between the two groups. However, when analyzed as a continuous variable, eGFR emerged as a predictor of 1-year mortality, both in univariate analysis (OR = 0.97, 95% CI: 0.95–0.99, p = 0.005) and in multivariate analysis, after adjusting for cardiogenic shock and Thrombolysis in Myocardial Infarction TIMI 0/1 flow (OR = 0.975, 95% CI: 0.95–0.99, p = 0.021). Conclusions: In STEMI with PPCI on a left main culprit lesion, renal failure was associated with more complex coronary lesions and less complete revascularization, and turned out to be an independent predictor of mortality at 1-year follow-up.

Association between Serum Osteoprotegerin Levels and Severity of Coronary Artery Disease in Patients with Acute Myocardial Infarction

“…These thresholds, close to those of our current work, could be proposed as a reference limit beyond which we could consider ischemia testing in patients at high CV risk. In agreement with the literature, we found that CV risk factors, such as hypercholesterolemia, CV history and elevated creatinine level, were strong predictors of extensive CAD [ 27 , 28 , 29 ]. Given the potential therapeutic strategies targeting VC, further studies are thus needed to better understand the place of OPG as a biomarker in ASCVD [ 30 ].…”

Long-Term Prognostic Significance of High-Sensitive Troponin I Increase during Hospital Stay in Patients with Acute Myocardial Infarction and Non-Obstructive Coronary Arteries

“…Renal failure expressed as elevated markers of kidney function impairment in the serum is a well-known factor related to poorer clinical outcomes in patients with MI-CAD and treated with primary PCI. Furthermore, this relationship was also confirmed in the current study on MACCE rate [ 29 ].…”

Optical Coherence Tomography for In Vivo Identification, Characterization and Optimal Treatment of Spontaneous Recanalization of Coronary Thrombus

“…It was previously believed that the true prevalence of SRCT lesions might be underestimated, due to its angiographic non-specific aspect: namely haziness, braided and pseudo-dissection filling defects. This angiographic aspect can be related to other various conditions: fresh thrombosis on plaque rupture/erosion, spontaneous dissection, aneurysm or heavy calcification (2,(36)(37)(38)(39)(40). The diagnosis becomes possible only by intravascular imaging.…”