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In-hospital complications in acute ST-elevation myocardial infarction depending on renal function

Stationäre Komplikationen bei akutem ST-Hebungsinfarkt in Abhängigkeit von der Nierenfunktion

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Abstract

Background

To analyze in-hospital complications in patients with acute ST-elevation myocardial infarction (STEMI) depending on renal function.

Design

Observational study in patients with STEMI.

Methods

The study included 169 patients undergoing primary percutaneous coronary intervention. In all patients glomerular filtration rate (GRF) was calculated using the Modification of Diet in Renal Disease Study (MDRD) equation. Of these patients, 84 had a GFR ≥ 90 ml/min/1.73 m2 (Group 1) and 85 < 90 ml/min/1.73 m2 (Group 2). Other parameters in both groups were comparable. Study groups were followed to compare Killip class > 2 acute heart failure, in-hospital pneumonia, pulseless ventricular tachycardia or ventricular fibrillation, new onset atrial fibrillation, and high grade atrioventricular block. All patients were treated according to European Society of Cardiology (ESC) guidelines for the management of acute myocardial infarction in patients presenting with ST elevation.

Results

Mean GFR in Group 1 was 107.6 \(\pm 17.8\) and in Group 2 75.3 \(\pm\) 11.2 (p < 0.0001). The incidence of atrial fibrillation was higher in Group 2: in Group 1 and Group 2 the atrial fibrillation rate was 1.12% (one of 84) vs 8.24% (seven of 85) (p = 0.031), respectively. Group 1 revealed significantly lower rates of acute heart failure (Killip class > 2): in Group 1 and Group 2 0% (0 of 84 patients) vs 5.88% (five of 85 patients) (p = 0.024), respectively. The authors found no significant differences for other complications: in Group 1 and Group 2 ventricular tachycardia or ventricular fibrillation was 4.76% (four of 84 patients) vs 5.89% (five of 85 patients) (p = 0.75), high grade atrioventricular block was 2.38% (two of 84 patients) vs 4.71% (four of 85 patients) (p = 0.41), and the in-hospital pneumonia rate was 2.38% (two of 84 patients) vs 4.71% (four of 85 patients) (p = 0.41), respectively.

Conclusion

Patients with lower GFR were more likely to suffer from in-hospital acute heart failure (Killip class > 2) and atrial fibrillation in STEMI despite primary percutaneous coronary intervention. Renal function did not affect in-hospital pneumonia, pulseless ventricular tachycardia or ventricular fibrillation rates. The evaluation of kidney function through GFR in STEMI patients may make in-hospital complications more predictable.

Zusammenfassung

Hintergrund

Die sich stationär bei Patienten mit akutem ST-Hebungsinfarkt (STEMI [„ST-elevation myocardial infarction“]) ereignenden Komplikationen wurden bezüglich ihrer Abhängigkeit von der Nierenfunktion analysiert.

Studiendesign

Es handelte sich um eine Beobachtungsstudie bei STEMI-Patienten.

Methoden

In die Studie wurden 169 Patienten, die einer primären perkutanen koronaren Intervention unterzogen worden waren, eingeschlossen. Bei allen Probanden wurde die glomeruläre Filtrationsrate (GFR) mittels der Gleichung der MRDR-Studie (MDRD: „modification of diet in renal disease“) ermittelt. Von ihnen hatten 84 eine GFR ≥ 90 ml/min/1,73 m2 (Gruppe 1) und 85 eine GFR < 90 ml/min/1,73 m2 (Gruppe 2). Andere Parameter beider Gruppen waren vergleichbar. Die Studiengruppen wurden bezüglich der Häufigkeit des Auftretens von akuter Herzinsuffizienz (Killip-Klasse > 2), im Krankenhaus auftretender Pneumonie, pulsloser ventrikulärer Tachykardie oder Kammerflimmern, neu auftretendem Vorhofflimmern und hochgradigem atrioventrikulärem (AV) Block verglichen. Alle Patienten wurden nach den ESC-Leitlinien (ESC: „European Society of Cardiology“) zum Management des akuten Myokardinfarkts bei ST-Hebung behandelt.

Ergebnisse

Die mittlere GFR in Gruppe 1 bzw. 2 war 107,6 \(\pm 17,8\) bzw. 75,3 \(\pm\)11,2 (p < 0,0001). Die Inzidenz von Vorhofflimmern war in Gruppe 2 höher: In Gruppe 1 betrug diese 1,12 % (1 von 84), in Gruppe 2 8,24 % (7 von 85; p = 0,031). Bei den Probanden von Gruppe 1 kam es signifikant seltener zur akuten Herzinsuffizienz (Killip-Klasse > 2): In Gruppe 1 trat diese bei 0 % (0 von 84 Patienten) auf vs. 5,88 % (5 von 85 Patienten) in Gruppe 2 (p =  0,024). Für die anderen Komplikationen wurden keine signifikanten Unterschiede festgestellt: Ventrikuläre Tachykardie oder Kammerflimmern traten in Gruppe 1 bei 4,76 % (4 von 84 Patienten), in Gruppe 2 bei 5,89 % (5 von 85 Patienten) auf (p = 0,75), ein hochgradiger AV-Block bei 2,38 % (2 von 84 Patienten) vs. 4,71 % (4 von 85 Patienten; p = 0,41), und stationär eine Pneumonie wurde bei 2,38 % (2 von 84 Patienten) bzw. 4,71 % (4 von 85 Patienten) beobachtet (p =  0,41).

Schlussfolgerung

Bei Patienten mit STEMI und niedriger GFR kam es trotz primärer perkutaner koronarer Intervention eher zur akuten Herzinsuffizienz (Killip-Klasse > 2) im Krankenhaus und Vorhofflimmern. Die Häufigkeiten des Auftretens von Pneumonie im Krankenhaus, pulsloser ventrikulärer Tachykardie oder Kammerflimmern waren nicht mit der Nierenfunktion assoziiert. Die Beurteilung der Nierenfunktion mittels GFR-Bestimmung bei STEMI-Patienten kann das Auftreten von Komplikationen im Krankenhaus vorhersehbarer machen.

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Acknowledgements

The authors would like to thank all patients that contributed to the success of the study.

Funding

No funding was received for this study.

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Authors and Affiliations

  1. Erebouni MC, 14 Titogradyan Street, 0087, Yerevan, Armenia

    Harutyun Petrosyan, Hamlet Hayrapetyan, Shahen Torozyan & Arsen Tsaturyan

  2. Bethel-Clinic, Bielefeld, Germany

    Sona Tribunyan

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  1. Harutyun Petrosyan
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  2. Hamlet Hayrapetyan
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Contributions

Hamlet Hayrapetyan and Harutyun Petrosyan conceived of the study. All authors participated in its design and coordination and helped to draft the manuscript. Hamlet Hayrapetyan and Harutyun Petrosyan drafted the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Harutyun Petrosyan.

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Conflict of interest

H. Petrosyan, H. Hayrapetyan, S. Torozyan, A. Tsaturyan and S. Tribunyan declare that they have no competing interests.

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Availability of data and material

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request

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Petrosyan, H., Hayrapetyan, H., Torozyan, S. et al. In-hospital complications in acute ST-elevation myocardial infarction depending on renal function. Herzschr Elektrophys 32, 359–364 (2021). https://doi.org/10.1007/s00399-021-00782-3

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  • DOI: https://doi.org/10.1007/s00399-021-00782-3

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