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Influence of chronic kidney disease and worsening renal function on clinical outcomes in patients undergoing primary percutaneous coronary intervention

  • Toshijiro Aoki
  • Hideki Ishii
  • Akihito Tanaka
  • Susumu Suzuki
  • Satoshi Ichimiya
  • Masaaki Kanashiro
  • Toyoaki Murohara
Original article

Abstract

Background

The combined influence of CKD and worsening renal function (WRF) on clinical outcomes in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) has not been fully understood.

Methods

We analyzed 443 patients diagnosed with AMI who underwent primary PCI. Based on their estimated glomerular filtration rate (eGFR), they were classified into two groups: a high eGFR group (eGFR ≥ 45 mL/min/1.73 m2, n = 381) and a low eGFR group (eGFR < 45 mL/min/1.73 m2, n = 63). WRF was defined as an increase in serum creatinine levels ≥ 0.3 mg/dL above the admission value during the course of hospitalization. The primary end-point was set as all-cause mortality.

Results

WRF was observed in 88 patients (19.8%). The median follow-up duration was 769 (interquartile range 397–1314) days. The all-cause mortality rate was significantly lower in the high eGFR than in the low eGFR group (5.5 vs. 28.6%, respectively, at 1500 days, P < 0.001). In patients with WRF, the all-cause and cardiac mortality rates were significantly higher than in patients without WRF, and these results were consistent between the high and low eGFR sub-groups. Multivariate Cox proportional hazards model analysis showed that low eGFR and WRF remained independent predictors of all-cause mortality [(hazard ratio 2.61, 95% confidence interval 1.27–5.36, P = 0.009) and (hazard ratio 2.59, 95% confidence interval 1.34–5.01, P = 0.005), respectively].

Conclusions

Both eGFR at baseline and WRF were observed to be important predictors of mortality in patients with AMI undergoing primary PCI. WRF showed a significant effect on mortality even in patients with high eGFR.

Keywords

Acute myocardial infarction Chronic kidney disease Worsening renal function Mortality 

Notes

Funding

This study was supported by Mitsui Life Social Welfare Foundation.

Compliance with ethical standards

Conflict of interest

H.I. received lecture fees from Astellas Pharma Inc., Astrazeneca Inc., Daiichi-Sankyo Pharma Inc. and MSD K.K. T. M. received lecture fees from Bayel Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Kowa Co., Ltd., MSD K.K., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co., Ltd., Novartis Pharma K.K., Pfizer Japan Inc., Sanofi-aventis K.K., and Takeda Pharmaceutical Co., Ltd. T.M.received unrestricted research grant for Department of Cardiology, Nagoya University Graduate School of Medicine from Astellas Pharma Inc, Daiichi Sankyo Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Kowa Co., Ltd., MSD K.K., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co., Ltd., Novartis Pharma K.K., Otsuka Pharma Ltd., Pfizer Japan Inc., Sanofi-aventis K.K., Takeda Pharmaceutical Co., Ltd., Teijin Pharma Ltd.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number 2011-1139 in Nagoya University Hospital and 2010-7 in Yokkaichi Municipal Hospital) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in this study.

Supplementary material

10157_2018_1622_MOESM1_ESM.pptx (169 kb)
Supplemental Figure 1: Kaplan–Meier curves for cardiac mortality rate according to WRF (a) and each eGFR group, high eGFR sub-group (b, solid lines) and low eGFR sub-group (b, dashed lines). WRF, worsening renal function; eGFR, estimated glomerular filtration rate (PPTX 169 KB)
10157_2018_1622_MOESM2_ESM.docx (20 kb)
Supplemental Figure 2: Kaplan–Meier curves for all-cause mortality rate according to each CKD stages. CKD, Chronic kidney disease (DOCX 19 KB)
10157_2018_1622_MOESM3_ESM.pptx (141 kb)
Supplementary material 3 (PPTX 140 KB)

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Copyright information

© Japanese Society of Nephrology 2018

Authors and Affiliations

  • Toshijiro Aoki
    • 1
  • Hideki Ishii
    • 1
  • Akihito Tanaka
    • 1
  • Susumu Suzuki
    • 1
  • Satoshi Ichimiya
    • 2
  • Masaaki Kanashiro
    • 2
  • Toyoaki Murohara
    • 1
  1. 1.Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
  2. 2.Department of CardiologyYokkaichi Municipal HospitalYokkaichiJapan

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