Renal impairment and mortality in patients with STEMI and cardiogenic shock/cardiac arrest.
Gautam R Shroff, Santiago Garcia, Christian Schmidt, Brynn Okeson, Edward Tannenbaum, Roberto Pacheco, Timothy D Smith, Ross Garberich, Scott Sharkey, Frank Aguirre, Mark Tannenbaum, Daniel Shivapour, Teresa Coulson, Timothy D Henry
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 2023 AugWe sought to study the association of renal impairment (RI) with mortality in ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock and/or cardiac arrest (CS/CA). Patients with RI (estimated glomerular filtration rate <60 mL/min/1.73 m2 ) were identified from the Midwest STEMI consortium, a prospective registry of four large regional programs comprising consecutive patients over 17 years. Primary outcome was in-hospital and 1-year mortality stratified by RI status and presence of CS/CA among patients with STEMI referred for coronary angiography. In a cohort of 13,463 STEMI patients, 13% (n = 1754) had CS/CA, 30% (n = 4085) had RI. Overall, in-hospital mortality was 5% (12% RI vs. 2% no-RI, p < 0.001) and 1-year mortality 9% (21% RI vs. 4% no-RI, p < 0.001). Among uncomplicated STEMI, in-hospital mortality was 2% (4% RI vs. 1% no-RI, p < 0.001) and 1-year mortality 6% (13% RI vs. 3% no-RI, p < 0.001). In STEMI with CS/CA, in-hospital mortality was 29% (43% RI vs. 15% no-RI, p < 0.001) and 1-year mortality 33% (50% RI vs. 16% no-RI, p < 0.001). Using Cox proportional hazards, RI was an independent predictor of in-hospital mortality in STEMI with CS/CA (odds ratio [OR]: 3.86; confidence interval [CI]: 2.6, 5.8). The association of RI with in-hospital and 1-year mortality is disproportionately greater in those with CS/CA compared to uncomplicated STEMI presentations. Factors predisposing RI patients to higher risk STEMI presentations and pathways to promote earlier recognition in the chain of survival need further investigation. © 2023 Wiley Periodicals LLC.
Citation
Gautam R Shroff, Santiago Garcia, Christian Schmidt, Brynn Okeson, Edward Tannenbaum, Roberto Pacheco, Timothy D Smith, Ross Garberich, Scott Sharkey, Frank Aguirre, Mark Tannenbaum, Daniel Shivapour, Teresa Coulson, Timothy D Henry. Renal impairment and mortality in patients with STEMI and cardiogenic shock/cardiac arrest. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions. 2023 Aug;102(2):179-190
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PMID: 37381622
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