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Impact of admission creatinine level on clinical outcomes of patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention with drug-eluting stent implantation.
Chin Med J (Engl). 2008 Dec 05; 121(23):2379-83.CM

Abstract

BACKGROUND

Prognosis of patients with acute ST-elevation myocardial infarction (STEMI) and renal dysfunction (RD) who received primary percutaneous coronary intervention (PCI) has not been fully investigated in the drug-eluting stent (DES) era. This study aimed to evaluate the impact of admission serum creatinine level on short-term outcomes in patients with acute STEMI undergoing DES-based primary PCI.

METHODS

Primary PCI with DES implantation was attempted in 619 consecutive STEMI patients within 12 hours of symptom onset. Among them, 86 patients had a serum creatinine level > or = 115 micromol/L on admission (RD group), and the remaining 533 patients had normal renal function (non-RD group). The primary endpoint was 30-day major adverse cardiac events (MACE, including death, non-fatal reinfarction, and target vessel revascularization), and the secondary endpoint was subacute stent thrombosis.

RESULTS

Patients in the RD group were older than those in the non-RD group. There are more female patients in the RD group and they had a history of hypertension, myocardial infarction and revascularization. The occurrence rates of Killip class > or = 2 (29.1% vs 18.6%, P = 0.02) and multi-vessel (62.8% vs 44.5%, P = 0.001) and triple vessel disease (32.6% vs 18.2%, P = 0.002), in-hospital mortality (9.3% vs 3.8%, P = 0.03), and MACE rate during hospitalization (17.4% vs 7.7%, P = 0.006) were higher in the RD group than those in the non-RD group. At a 30-day clinical follow-up, the MACE-free survival rate was significantly reduced in the RD group (76.7% vs 89.9%, P = 0.0003). Angiographic stent thrombosis occurred in 3 (3.5%) and 7 (1.3%) of patients in the RD group and non-RD group, respectively (P = 0.15). Multivariate analysis revealed that the serum creatinine level > or = 115 micromol/L on admission was an independent predictor for MACE rate at a 30-day follow-up (Hazard ratio (HR) 3.31, 95% CI 1.19 - 9.18, P < 0.001).

CONCLUSION

Despite similar prevalence of stent thrombosis at a 30-day clinical follow-up, the short-term prognosis of STEMI patients with elevated serum creatinine on admission undergoing DES-based primary PCI remains unfavorable.

Authors+Show Affiliations

Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19102952

Citation

Zhang, Qi, et al. "Impact of Admission Creatinine Level On Clinical Outcomes of Patients With Acute ST-elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention With Drug-eluting Stent Implantation." Chinese Medical Journal, vol. 121, no. 23, 2008, pp. 2379-83.
Zhang Q, Zhang RY, Shen J, et al. Impact of admission creatinine level on clinical outcomes of patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention with drug-eluting stent implantation. Chin Med J. 2008;121(23):2379-83.
Zhang, Q., Zhang, R. Y., Shen, J., Zhang, J. S., Hu, J., Yang, Z. K., Zhang, X., Zheng, A. F., & Shen, W. F. (2008). Impact of admission creatinine level on clinical outcomes of patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention with drug-eluting stent implantation. Chinese Medical Journal, 121(23), 2379-83.
Zhang Q, et al. Impact of Admission Creatinine Level On Clinical Outcomes of Patients With Acute ST-elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention With Drug-eluting Stent Implantation. Chin Med J. 2008 Dec 5;121(23):2379-83. PubMed PMID: 19102952.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of admission creatinine level on clinical outcomes of patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention with drug-eluting stent implantation. AU - Zhang,Qi, AU - Zhang,Rui-yan, AU - Shen,Jie, AU - Zhang,Jian-sheng, AU - Hu,Jian, AU - Yang,Zheng-kun, AU - Zhang,Xian, AU - Zheng,Ai-fang, AU - Shen,Wei-feng, PY - 2008/12/24/entrez PY - 2008/12/24/pubmed PY - 2009/3/27/medline SP - 2379 EP - 83 JF - Chinese medical journal JO - Chin. Med. J. VL - 121 IS - 23 N2 - BACKGROUND: Prognosis of patients with acute ST-elevation myocardial infarction (STEMI) and renal dysfunction (RD) who received primary percutaneous coronary intervention (PCI) has not been fully investigated in the drug-eluting stent (DES) era. This study aimed to evaluate the impact of admission serum creatinine level on short-term outcomes in patients with acute STEMI undergoing DES-based primary PCI. METHODS: Primary PCI with DES implantation was attempted in 619 consecutive STEMI patients within 12 hours of symptom onset. Among them, 86 patients had a serum creatinine level > or = 115 micromol/L on admission (RD group), and the remaining 533 patients had normal renal function (non-RD group). The primary endpoint was 30-day major adverse cardiac events (MACE, including death, non-fatal reinfarction, and target vessel revascularization), and the secondary endpoint was subacute stent thrombosis. RESULTS: Patients in the RD group were older than those in the non-RD group. There are more female patients in the RD group and they had a history of hypertension, myocardial infarction and revascularization. The occurrence rates of Killip class > or = 2 (29.1% vs 18.6%, P = 0.02) and multi-vessel (62.8% vs 44.5%, P = 0.001) and triple vessel disease (32.6% vs 18.2%, P = 0.002), in-hospital mortality (9.3% vs 3.8%, P = 0.03), and MACE rate during hospitalization (17.4% vs 7.7%, P = 0.006) were higher in the RD group than those in the non-RD group. At a 30-day clinical follow-up, the MACE-free survival rate was significantly reduced in the RD group (76.7% vs 89.9%, P = 0.0003). Angiographic stent thrombosis occurred in 3 (3.5%) and 7 (1.3%) of patients in the RD group and non-RD group, respectively (P = 0.15). Multivariate analysis revealed that the serum creatinine level > or = 115 micromol/L on admission was an independent predictor for MACE rate at a 30-day follow-up (Hazard ratio (HR) 3.31, 95% CI 1.19 - 9.18, P < 0.001). CONCLUSION: Despite similar prevalence of stent thrombosis at a 30-day clinical follow-up, the short-term prognosis of STEMI patients with elevated serum creatinine on admission undergoing DES-based primary PCI remains unfavorable. SN - 2542-5641 UR - https://www.unboundmedicine.com/medline/citation/19102952/Impact_of_admission_creatinine_level_on_clinical_outcomes_of_patients_with_acute_ST_elevation_myocardial_infarction_undergoing_primary_percutaneous_coronary_intervention_with_drug_eluting_stent_implantation_ L2 - http://Insights.ovid.com/pubmed?pmid=19102952 DB - PRIME DP - Unbound Medicine ER -