Correlation between Renal Function and PCI Outcome in STEMI Patients Treated with Primary PCI

Abstract

SUMMARY S TEMI represents an important cause of morbidity and mortality worldwide. The prevalence of CKD among patients with STEMI is high. Myocardial infarction is the main cause of death in CKD patients. This study was conducted at cardiology department Ain Shams university hospitals to evaluate the impact of chronic kidney disease on the interventional outcome in STEMI patients treated by primary PCI. 100 patients who were admitted to Ain Shams university hospitals with STEMI and treated with primary PCI were enrolled starting from April 2015 to November 2015 The patients were subjected to history & examination regarding demographic factors, traditional risk factors for CAD, past history of CAD including previous ACS or revascularization. The patients’ vital data and initial killip class and the patients’ weight were recorded. ECG was done on admission for STEMI localization and within 4hours after the procedure to evaluate procedural success. Full laboratory investigations were done with special attention to serum creatinine. Interventional data collected included the culprit vessel, the severity of coronary artery disease assessed by Gensini score, type of intervention performed, type of stent used, occurrence of complications and assessment of epicardial coronary artery flow and myocardial reperfusion initially, after stent deployment and at the end of the procedure by TIMI flow and MBG respectively. Rate of procedural success was defined by both angiographic criteria (TIMI III flow with MBG ≥2 at the end of the procedure) & ECG criteria (Resolution of ≥70% of ST elevation within 4hrs of the procedure) Patients were stratified according to CrCl (Calculated by CG formula) and eGFR (calculated by MDRD formula) into normal renal functions group, moderate renal dysfunction group and severe renal dysfunction group. The majority of patients were males with mean age of 57 years. 64% were current smokers while 44 patients had HTN 34 patients had DM.24 patients had history of prior ACS while 8 patients had a history of prior PCI. Only 2 patients had prior CABG. 7 patients initial Killip was ≥3. 63 patients had anterior STEMI. Thrombus aspiration was done in 21 patients. 94 patients received stents of which 60% had direct stenting while DES were used in 16 patients direct stenting was done in 60 patients, while it was proceeded by thrombus aspiration in 16 patients, by PTCA in 17 patients and by both in one patient. DES were used in 16 patients