In Turkish Geriatric Patients with Myocardial Infarction Undergoing Primary PCI Risk Factors Determining in-Hospital Mortality and The Relationship Between Kidney Function
Abstract
Geriatric population (>80 years) has an increased mortality risk due to several reasons including more extensive coronary artery disease (CAD) and impaired renal function. We investigated the relationship between in-hospital mortality and renal dysfunction in geriatric patients with ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous intervention (PCI). We included 203 geriatric patients with STEMI who underwent primary PCI. Patients were divided into 2 groups; group 1 comprised 42 patients who died in the hospital after MI, and group 2 included 161 patients who were discharged following primary PCI. The risk factors of the patients were determined. We calculated coronary artery disease prevalence by Gensini risk score, renal function by creatinine clearance (CrCl), and compared 2 groups. The patients in group 1 who died in hospital after STEMI were older; they had more extensive CAD and lower CrCl (age: 82 ± 5 yr, 78 ± 7 yr, p<0.001; Gensini score: 70 ± 30, 42 ± 26, p: 0.001; CrCl: 46 ± 17 mL/min, 65 ± 18 mL/min, p<0.001). When multivariate analysis was performed with logistic regression, we found to be CrCl, HDL-cholesterol, and Gensini scores to be the independent predictors of in-hospital mortality (CCL: OR 1.057 (1.029-1.086), p = 0.001); HDL: OR 1.077 (1.021-1.136), p = 0.007, Gensini score: OR 0.969 (0.952-0.985), p = 0.001). Renal dysfunction increases in-hospital mortality in elderly patients with STEMI undergoing primary PCI. Renal dysfunction in elderly patients with MI is an important risk factor that increases in-hospital mortality like other cardiovascular risk factors.
Keywords
Geriatric population ST elevation myocardial infarction renal function creatinine clearance Gensini score.
Project Number
yok
References
- Mendis S. Cardiovascular risk assessment and management in developing countries. Vasc Health Risk Manag. 2005; 1(1): 15-18. DOI:10.2147/vhrm.1.1.15.58933.
- Ichikawa K, Konta T, Ikeda A, et al. Significance of past history of renal failure for the detection of high-risk individuals for cardiovascular and end-stage renal disease: analysis of data from a nationwide health checkup. Clin Exp Nephrol. 2011; 15(6): 841-847. DOI:10.1007/s10157-011-0509-y.
- Furuhashi T, Moroi M, Joki N, et al. The impact of chronic kidney disease as a predictor of major cardiac events in patients with no evidence of coronary artery disease. J Cardiol. 2010; 55(3): 328-336. DOI:10.1016/j.jjcc.2009.12.009.
- Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization [published correction appears in N Engl J Med. 2008;18(4):4]. N Engl J Med. 2004; 351(13): 1296-1305. DOI:10.1056/NEJMoa041031.
- Meisinger C, Döring A, Löwel H; KORA Study Group. Chronic kidney disease and risk of incident myocardial infarction and all-cause and cardiovascular disease mortality in middle-aged men and women from the general population. Eur Heart J. 2006; 27(10): 1245-1250. DOI:10.1093/eurheartj/ehi880.
- Manjunath G, Tighiouart H, Ibrahim H, et al. Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community. J Am Coll Cardiol. 2003; 41(1): 47-55. DOI:10.1016/s0735-1097(02)02663-3.
- Yazici HU, Durak MI, Ulus T, et al. The effect of aging on outcomes of Primary percutaneous coronary Intervention in patients with acute Myocardial infarction. Turkish Journal of Geriatrics 2012; 15(3) 255-259.
- Morici N, De Servi S, Toso A, et al. Renal dysfunction, coronary revascularization and mortality among elderly patients with non ST elevation acute coronary syndrome. Eur Heart J Acute Cardiovasc Care. 2015; 4(5): 453-460. DOI:10.1177/2048872614557221.
- Rampidis GP, Benetos G, Benz DC, Giannopoulos AA, Buechel RR. A guide for Gensini Score calculation. Atherosclerosis. 2019; 287: 181-183. DOI:10.1016/j.atherosclerosis.2019.05.012.
- Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction [published correction appears in J Am Coll Cardiol 2001 Mar 1;37(3):973]. J Am Coll Cardiol. 2000; 36(3): 959-969. DOI:10.1016/s0735-1097(00)00804-4.
- Gibson CM, Cannon CP, Daley WL, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996; 93(5): 879-888. DOI:10.1161/01.cir.93.5.879.
- Baber U, Auguste U. Patients with chronic kidney disease/diabetes mellitus: the high-risk profile in acute coronary syndrome. Curr Cardiol Rep. 2013; 15(8): 386. DOI:10.1007/s11886-013-0386-y.
- Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298(17):2038-2047. doi:10.1001/jama.298.17.2038.
- Al Suwaidi J, Reddan DN, Williams K, et al. Prognostic implications of abnormalities in renal function in patients with acute coronary syndromes. Circulation. 2002; 106(8): 974-980. doi:10.1161/01.cir.0000027560.41358.b3.
- Anavekar NS, McMurray JJ, Velazquez EJ, et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med. 2004; 351(13): 1285-1295. DOI:10.1056/NEJMoa041365.
- Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), Steg PG, James SK, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012; 33(20): 2569-2619. DOI:10.1093/eurheartj/ehs215.
- Noël D, Landais P. Epidémiologie de la maladie rénale chronique [Epidemiology of chronic kidney disease] [published correction appears in Rev Prat. 2012; 62(2): 197]. Rev Prat. 2012; 62(1): 38-42.
- Munang LA, Starr JM. Diseases of the Aging Kidney. In: Fillit HM, Rockwood K, Woodhouse K, eds. Brocklehurst’s Textbook of Geriatric Medicine and Gerontology. 7th ed. Philadelphia: Saunders-Elsevier; 2010: 690-696.
- Graham MM, Ghali WA, Faris PD, et al. Survival after coronary revascularization in the elderly. Circulation. 2002; 105(20): 2378-2384. DOI:10.1161/01.cir.0000016640.99114.3d.
- Savonitto S, Cavallini C, Petronio AS, et al. Early aggressive versus initially conservative treatment in elderly patients with non-ST-segment elevation acute coronary syndrome: a randomized controlled trial. JACC Cardiovasc Interv. 2012; 5(9): 906-916. DOI:10.1016/j.jcin.2012.06.008.
- Angeli F, Verdecchia P, Savonitto S, Morici N, De Servi S, Cavallini C. Early invasive versus selectively invasive strategy in patients with non-ST-segment elevation acute coronary syndrome: impact of age. Catheter Cardiovasc Interv. 2014; 83(5): 686-701. DOI:10.1002/ccd.25307.
- Kim IY, Hwang IH, Lee KN, et al. Decreased renal function is an independent predictor of severity of coronary artery disease: an application of Gensini score. J Korean Med Sci. 2013; 28(11): 1615-1621. DOI:10.3346/jkms.2013.28.11.1615.
- Wright RS, Reeder GS, Herzog CA, et al. Acute myocardial infarction and renal dysfunction: a high-risk combination. Ann Intern Med. 2002; 137(7): 563-570. DOI:10.7326/0003-4819-137-7-200210010-00007.
- Menon V, Sarnak MJ, Lessard D, Goldberg RJ. Recent trends in hospital management practices and prognosis after acute myocardial infarction in patients with kidney disease. Am J Cardiol. 2004; 94(10): 1290-1293. DOI:10.1016/j.amjcard.2004.07.116.
- Seyfarth M, Kastrati A, Mann JF, et al. Prognostic value of kidney function in patients with ST-elevation and non-ST-elevation acute myocardial infarction treated with percutaneous coronary intervention. Am J Kidney Dis. 2009; 54(5): 830-839. DOI:10.1053/j.ajkd.2009.04.03.
- Medi C, Chew DP, Amerena J, et al. An invasive management strategy is associated with improved outcomes in high-risk acute coronary syndromes in patients with chronic kidney disease. Intern Med J. 2011; 41(10): 743-750.
- Medi C, Chew DP, Amerena J, et al. An invasive management strategy is associated with improved outcomes in high-risk acute coronary syndromes in patients with chronic kidney disease. Intern Med J. 2011; 41(10): 743-750. DOI:10.1111/j.1445-5994.2010.02361.x.
- Wilson WM, Andrianopoulos N, Clark D, et al. Long-term predictors of mortality after percutaneous coronary intervention in the era of drug-eluting stents. Am J Cardiol. 2011; 108(7): 936-942. DOI:10.1016/j.amjcard.2011.05.024.
- de Mulder M, van der Ploeg T, de Waard GA, Boersma E, Umans VA. Admission glucose does not improve GRACE score at 6 months and 5 years after myocardial infarction. Cardiology. 2011; 120(4): 227-234. DOI:10.1159/000335715.
- Morel O, El Ghannudi S, Jesel L, et al. Cardiovascular mortality in chronic kidney disease patients undergoing percutaneous coronary intervention is mainly related to impaired P2Y12 inhibition by clopidogrel. J Am Coll Cardiol. 2011; 57(4): 399-408. DOI:10.1016/j.jacc.2010.09.032.
Primer Perkütan Koroner Girişim Yapılan Miyokard İnfarktüslü Türk Geriatrik Hastalarda Hastane İçi Mortalitesini Belirleyen Risk Faktörleri ve Böbrek Fonksiyonu Arasındaki İlişki
Abstract
Geriatrik popülasyon (>80 yaş), daha yaygın koroner arter hastalığı (KAH) ve bozulmuş böbrek fonksiyonu gibi çeşitli nedenlerden dolayı artmış mortalite riskine sahiptir. Primer perkütan girişim (PCI) uygulanan ST yükselmeli miyokard enfarktüsü (STEMI) olan geriatrik hastalarda hastane içi mortalite ile böbrek fonksiyon bozukluğu arasındaki ilişkiyi araştırdık. Primer PCI uygulanan STEMI'li 203 geriatrik hastayı dahil ettik. Hastalar 2 gruba ayrıldı; grup 1, Miyokard infarktüsü (MI) sonrası hastanede ölen 42 hastadan, grup 2 ise primer PKG sonrası taburcu edilen 161 hastadan oluşuyordu. Hastaların risk faktörleri belirlendi. Koroner arter hastalığı prevalansını Gensini risk skoru ile, renal fonksiyonu kreatinin klirensi (CrCl) ile hesapladık ve 2 grubu karşılaştırdık. Grup 1'de STEMI sonrası hastanede ölen hastalar daha yaşlıydı; daha yaygın KAH ve daha düşük CrCl'ye sahiptiler (yaş: 82 ± 5 yıl, 78 ± 7 yıl, p<0.001; Gensini skoru: 70 ± 30, 42 ± 26, p: 0.001; CrCl: 46 ± 17 mL/dk, 65 ± 18 mL/dak, p<0.001). Lojistik regresyon ile çok değişkenli analiz yapıldığında CrCl, HDL-kolesterol ve Gensini skorlarının hastane içi mortalitenin bağımsız öngördürücüleri olduğunu bulduk (CCL: OR 1.057 (1.029-1.086), p = 0.001); HDL: OR 1.077 (1.021-1.136), p = 0.007, Gensini skoru: OR 0.969 (0.952-0.985), p = 0.001). Primer PKG uygulanan STEMI'li yaşlı hastalarda renal disfonksiyon hastane içi mortaliteyi artırmaktadır. MI'lı yaşlı hastalarda böbrek fonksiyon bozukluğu, diğer kardiyovasküler risk faktörleri gibi hastane içi mortaliteyi artıran önemli bir risk faktörüdür.
Keywords
Geriatrik popülasyon ST yükselmeli miyokard infarktüsü böbrek fonksiyonu kreatinin klirensi Gensini skoru.
Supporting Institution
yok
Project Number
yok
References
- Mendis S. Cardiovascular risk assessment and management in developing countries. Vasc Health Risk Manag. 2005; 1(1): 15-18. DOI:10.2147/vhrm.1.1.15.58933.
- Ichikawa K, Konta T, Ikeda A, et al. Significance of past history of renal failure for the detection of high-risk individuals for cardiovascular and end-stage renal disease: analysis of data from a nationwide health checkup. Clin Exp Nephrol. 2011; 15(6): 841-847. DOI:10.1007/s10157-011-0509-y.
- Furuhashi T, Moroi M, Joki N, et al. The impact of chronic kidney disease as a predictor of major cardiac events in patients with no evidence of coronary artery disease. J Cardiol. 2010; 55(3): 328-336. DOI:10.1016/j.jjcc.2009.12.009.
- Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization [published correction appears in N Engl J Med. 2008;18(4):4]. N Engl J Med. 2004; 351(13): 1296-1305. DOI:10.1056/NEJMoa041031.
- Meisinger C, Döring A, Löwel H; KORA Study Group. Chronic kidney disease and risk of incident myocardial infarction and all-cause and cardiovascular disease mortality in middle-aged men and women from the general population. Eur Heart J. 2006; 27(10): 1245-1250. DOI:10.1093/eurheartj/ehi880.
- Manjunath G, Tighiouart H, Ibrahim H, et al. Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community. J Am Coll Cardiol. 2003; 41(1): 47-55. DOI:10.1016/s0735-1097(02)02663-3.
- Yazici HU, Durak MI, Ulus T, et al. The effect of aging on outcomes of Primary percutaneous coronary Intervention in patients with acute Myocardial infarction. Turkish Journal of Geriatrics 2012; 15(3) 255-259.
- Morici N, De Servi S, Toso A, et al. Renal dysfunction, coronary revascularization and mortality among elderly patients with non ST elevation acute coronary syndrome. Eur Heart J Acute Cardiovasc Care. 2015; 4(5): 453-460. DOI:10.1177/2048872614557221.
- Rampidis GP, Benetos G, Benz DC, Giannopoulos AA, Buechel RR. A guide for Gensini Score calculation. Atherosclerosis. 2019; 287: 181-183. DOI:10.1016/j.atherosclerosis.2019.05.012.
- Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction [published correction appears in J Am Coll Cardiol 2001 Mar 1;37(3):973]. J Am Coll Cardiol. 2000; 36(3): 959-969. DOI:10.1016/s0735-1097(00)00804-4.
- Gibson CM, Cannon CP, Daley WL, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996; 93(5): 879-888. DOI:10.1161/01.cir.93.5.879.
- Baber U, Auguste U. Patients with chronic kidney disease/diabetes mellitus: the high-risk profile in acute coronary syndrome. Curr Cardiol Rep. 2013; 15(8): 386. DOI:10.1007/s11886-013-0386-y.
- Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298(17):2038-2047. doi:10.1001/jama.298.17.2038.
- Al Suwaidi J, Reddan DN, Williams K, et al. Prognostic implications of abnormalities in renal function in patients with acute coronary syndromes. Circulation. 2002; 106(8): 974-980. doi:10.1161/01.cir.0000027560.41358.b3.
- Anavekar NS, McMurray JJ, Velazquez EJ, et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med. 2004; 351(13): 1285-1295. DOI:10.1056/NEJMoa041365.
- Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), Steg PG, James SK, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012; 33(20): 2569-2619. DOI:10.1093/eurheartj/ehs215.
- Noël D, Landais P. Epidémiologie de la maladie rénale chronique [Epidemiology of chronic kidney disease] [published correction appears in Rev Prat. 2012; 62(2): 197]. Rev Prat. 2012; 62(1): 38-42.
- Munang LA, Starr JM. Diseases of the Aging Kidney. In: Fillit HM, Rockwood K, Woodhouse K, eds. Brocklehurst’s Textbook of Geriatric Medicine and Gerontology. 7th ed. Philadelphia: Saunders-Elsevier; 2010: 690-696.
- Graham MM, Ghali WA, Faris PD, et al. Survival after coronary revascularization in the elderly. Circulation. 2002; 105(20): 2378-2384. DOI:10.1161/01.cir.0000016640.99114.3d.
- Savonitto S, Cavallini C, Petronio AS, et al. Early aggressive versus initially conservative treatment in elderly patients with non-ST-segment elevation acute coronary syndrome: a randomized controlled trial. JACC Cardiovasc Interv. 2012; 5(9): 906-916. DOI:10.1016/j.jcin.2012.06.008.
- Angeli F, Verdecchia P, Savonitto S, Morici N, De Servi S, Cavallini C. Early invasive versus selectively invasive strategy in patients with non-ST-segment elevation acute coronary syndrome: impact of age. Catheter Cardiovasc Interv. 2014; 83(5): 686-701. DOI:10.1002/ccd.25307.
- Kim IY, Hwang IH, Lee KN, et al. Decreased renal function is an independent predictor of severity of coronary artery disease: an application of Gensini score. J Korean Med Sci. 2013; 28(11): 1615-1621. DOI:10.3346/jkms.2013.28.11.1615.
- Wright RS, Reeder GS, Herzog CA, et al. Acute myocardial infarction and renal dysfunction: a high-risk combination. Ann Intern Med. 2002; 137(7): 563-570. DOI:10.7326/0003-4819-137-7-200210010-00007.
- Menon V, Sarnak MJ, Lessard D, Goldberg RJ. Recent trends in hospital management practices and prognosis after acute myocardial infarction in patients with kidney disease. Am J Cardiol. 2004; 94(10): 1290-1293. DOI:10.1016/j.amjcard.2004.07.116.
- Seyfarth M, Kastrati A, Mann JF, et al. Prognostic value of kidney function in patients with ST-elevation and non-ST-elevation acute myocardial infarction treated with percutaneous coronary intervention. Am J Kidney Dis. 2009; 54(5): 830-839. DOI:10.1053/j.ajkd.2009.04.03.
- Medi C, Chew DP, Amerena J, et al. An invasive management strategy is associated with improved outcomes in high-risk acute coronary syndromes in patients with chronic kidney disease. Intern Med J. 2011; 41(10): 743-750.
- Medi C, Chew DP, Amerena J, et al. An invasive management strategy is associated with improved outcomes in high-risk acute coronary syndromes in patients with chronic kidney disease. Intern Med J. 2011; 41(10): 743-750. DOI:10.1111/j.1445-5994.2010.02361.x.
- Wilson WM, Andrianopoulos N, Clark D, et al. Long-term predictors of mortality after percutaneous coronary intervention in the era of drug-eluting stents. Am J Cardiol. 2011; 108(7): 936-942. DOI:10.1016/j.amjcard.2011.05.024.
- de Mulder M, van der Ploeg T, de Waard GA, Boersma E, Umans VA. Admission glucose does not improve GRACE score at 6 months and 5 years after myocardial infarction. Cardiology. 2011; 120(4): 227-234. DOI:10.1159/000335715.
- Morel O, El Ghannudi S, Jesel L, et al. Cardiovascular mortality in chronic kidney disease patients undergoing percutaneous coronary intervention is mainly related to impaired P2Y12 inhibition by clopidogrel. J Am Coll Cardiol. 2011; 57(4): 399-408. DOI:10.1016/j.jacc.2010.09.032.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Project Number | yok |
| Publication Date | March 30, 2023 |
| Submission Date | January 19, 2023 |
| Published in Issue | Year 2023 Volume: 2 Issue: 1 |
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