Different types of renal dysfunction in patients with acute myocardial infarction treated with percutaneous coronary intervention.

Background: The prognostic significance of different types of renal dysfunction in patients with acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI) has not been well characterized.

Methods: The single-center AMI registry encompassed 1,486 consecutive AMI patients treated with PCI, who were followed by mean 29.7 months. Subjects with an estimated glomerular filtration rate <60 mL/min per 1.73 m2 at baseline were selected (n = 283, 19.0%) and incorporated into the chronic kidney disease (CKD) group. The control group consisted of 1,203 subjects with normal renal function (81.0%). The CKD patients were divided into subgroups: with contrast-induced nephropathy - CKD + CIN (n = 68, 4.6%) and without - CKD-CIN (n = 215, 14.5%).

Results: Remote mortality rate was significantly higher in CKD group (34.6%) and in particular subgroups: CKD + CIN (47.0%), CKD-CIN (31.0%) than in controls (9.1%, P < 0.001 for all study groups vs controls). Multivariate analysis identified CKD as an independent predictor of any-cause death in the whole population (hazard ratio [HR] 1.77, 95% confidence interval [CI] 1.60-1.94, P < 0.001). Similarly, CKD + CIN contrary to CKD-CIN had significant and independent influence on remote survival in study population (HR 2.16, 95% CI 1.95-2.37, P < 0.001).

Conclusions: CKD and its types have significant, negative influence on long-term survival in AMI patients treated with PCI. It is especially strongly expressed in those CKD patients who develop contrast-induced nephropathy, which occurrence is an independent risk factor of mortality associated with over twofold increase of death hazard.