Creatinine clearance is independently associated with one year mortality in a primary PCI cohort with cardiogenic shock.

Background: Acute ST-segment elevation myocardial infarction (STEMI) complicated with cardiogenic shock (CS) has still the highest in hospital mortality. Patients with STEMI and increasing creatinine levels within 24 h after admission have a poor prognosis. Data about STEMI complicated with CS and kidney function are sparse. We sought to assess the prognostic value of creatinine clearance on admission in patients with STEMI and CS treated with percutaneous coronary intervention (PCI).

Methods And Results: Between 1997 and 2005, a total of 3038 patients presented with STEMI and treated with PCI. On admission 292 patients presented with CS. Creatinine clearance (CrCl) could be calculated in 193 patients and classified in tertiles: group I > 96.8 ml/min; Group II between 67.5 and 96.8 ml/min; Group III < 67.5 ml/min. Overall one year mortality was 34%. In group I, II and III mortality was 24%, 30% and 45% respectively (P for trend 0.009). In multivariate logistic regression analysis, the odds for mortality increased with 96% for each tertile of admission CrCl (OR 1.961, 95%CI 1,135-3.385, P=0.016).

Conclusion: Creatinine clearance on admission is strongly associated with one year mortality in STEMI patients with CS on admission and treated with PCI.