Clinical Outcomes of Chronic Kidney Disease Patients with STEMI Treated with Percutaneous Coronary Intervention: A Single Centre Study

Background: Patients with advanced chronic kidney disease sustain extremely high mortality rates following acute myocardial infarction. Nauta et al. evaluated temporal trends in 12,087 patients with acute myocardial infarction from a single institution over 24 years and report a reduction in 30-day mortality in the most recent decade for all patients, including patients with chronic kidney disease. This trend is optimistic, but understanding contributory factors would be critical in future studies to further improve survival. Patients with renal impairment were often left out from most major clinical trials assessing the optimal treatment for ST-elevation myocardial infarction (STEMI). We aim to analyze the outcomes of STEMI patients with renal impairment treated with coronary angioplasty. Methods: STEMI patients treated with percutaneous coronary intervention (PCI) were stratified into presence (GFR less than 60 ml/min/1.73m2 ) or absence (GFR ? 60 ml/min/1.73m2 ) of chronic kidney disease (CKD). Patient?s demographics, extent of coronary artery disease, procedural data, discharge medications, short (in-hospital) and long (1 year) term outcomes were critically assessed. Results: A total of 840 patients were included in the final analysis. STEMI CKD cohort was predominantly male (91%) with a mean age of 62.05 ? 10.75 years. They had higher cardiovascular risk factors namely diabetes mellitus (64%), hypertension (93%) and dyslipidemia (74%) in contrast to those without CKD. There were notably higher percentage of CKD patients presented with Killip class 3 and 4; 28 vs 8.75%. Thrombolytic therapy remained the most commonly instituted treatment regardless the status of kidney function. Furthermore, our STEMI CKD cohort also was more likely to receive less of evidence-based treatment upon discharge. In terms of outcomes, patients with CKD were more likely to develop in-hospital death (OR: 4.15, 95% CI 3.02?6.79), MACE (OR: 3.44, 95% CI 2.09?4.78) and vascular complications (OR: 1.79, 95% CI 0.89?4.2) compared to the non-CKD patients. The risk of death at 1-year post PCI in STEMI CKD patients was also reported to be high (HR: 3.88, 95% CI 2.81?5.18). Conclusion: STEMI and CKD is a deadly combination, proven in our cohort, adding on to the current evidence in the literature. We noted that our STEMI CKD patients tend to be younger with extremely high prevalence of diabetes mellitus. The poor outcome mainly driven by immediate or short termperi-procedural adverse events, therefore suggests that a more efficient treatment in this special group is imperative.