Relation of In-hospital Serum Creatinine Change Patterns and Outcomes among ST Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Intervention

Purpose: The worsening of serum creatinine (sCr) level is a frequent finding among ST segment elevation MI (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) ,associated with adverse short and long term outcomes. No information is present however regarding the incidence and prognostic implications associated with an improvement in sCr levels throughout hospitalization, as compared to the admission levels.

Methods: We retrospectively studied 1260 STEMI patients undergoing primary PCI. The incidence of in-hospital complications and long term mortality was compared between patients having stable, worsened (> 0.3 mg/dl increase), or improved ( > 0.3 mg/dl decrease) sCr levels throughout hospitalization .

Results: Overall 127 patients (10%) had an increase in sCr levels while 44 patients (3.5%) had a decrease in sCr compared to admission levels. Patients with worsening of sCR had more complications during hospitalization, with higher 30 day (13% vs. 1%; p <0.001) and up to5 -year all-cause mortality (28% vs. 5%; p<0.001) compared to those with stable sCR. No significant difference was found regarding complications and mortality between patients having decrease in sCr and stable sCr. Compared to patients with stable sCr, the adjusted hazard ratio for all-cause mortality in patients with worsened sCr was 6.68 (95% confidence interval: 2.1 - 21.6, p=0.002).

Conclusion: In STEMI patients undergoing primary PCI, renal impairment prior to PCI is a frequent finding. In contrast to post-PCI sCr worsening, this entity is not associated with adverse short and long term outcomes.









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