Estimated Glomerular Filtration Rate as a Useful Predictor of Mortality in Patients With Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

BackgroundThis study evaluated the impact of estimated glomerular filtration rate (eGFR) on 30-day and 1-year mortalities in patients with an acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).MethodsBetween January 2002 and November 2009, 1432 consecutive patients who had experienced STEMI with an onset of chest pain < 12 hours of undergoing primary PCI were prospectively enrolled. Patients were categorized into group 1 (eGFR < 30 mL/min/1.73 m2), group 2 (eGFR = 30–60 mL/min/1.73 m2) and group 3 (eGFR > 60 mL/min/1.73 m2).ResultsThe incidence of a high Killip class (defined as class ≥ 3) upon presentation, a requirement for mechanical ventilatory support for respiratory failure and intra-aortic balloon pump support for hemodynamic instability, and duration of hospitalization were substantially higher in group 1 than in groups 2 and 3, and notably higher in group 2 compared with group 3 (all P < 0.001). Conversely, the procedural success of primary PCI was remarkably lower in group 1 compared with groups 2 and 3, and it was also notably lower in group 2 than in group 3 (all P < 0.001). Additionally, both 30-day and 1-year mortalities were markedly increased in group 1 than in groups 2 and 3, and significantly higher in group 2 than in group 3 (all P < 0.001). Multivariate analysis showed that eGFR < 30 mL/min/1.73 m2 was a significantly independent predictor of 30-day and 1-year mortalities (all P < 0.001).ConclusionseGFR < 30 mL/min/1.73 m2 was strongly and independently predictive of poor short-term and long-term prognostic outcomes in patients with STEMI undergoing primary PCI.