Renal impairment and mortality in patients with STEMI and cardiogenic shock/cardiac arrest

Abstract

AbstractObjectivesWe 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).MethodsPatients 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.ResultsIn 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).ConclusionsThe 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.