In-hospital adverse clinical outcomes of ST elevation myocardial infarction patients with renal dysfunction. Insights from the Saudi Project for Assessment of Coronary Events.

OBJECTIVES: To explore the prognostic value of baseline estimated glomerular filtration rate (eGFR) in Saudi patients presenting with ST elevation myocardial infarction (STEMI), and its impact on hospital therapies.

METHODS: The STEMI patients with a baseline serum Creatinine enrolled in the SPACE (Saudi Project for Assessment of Coronary Events) registry were analyzed. This study was performed in several regions in Saudi Arabia between December 2005 to December 2007. Based on eGFR levels, patients were classified into: more than 90.1 ml/min (normal renal function), 90-60.1 (borderline/mildly impaired renal function), 60-30 (moderate renal dysfunction), and less than 30 ml/min/1.73 m2 (severe renal dysfunction).

RESULTS: Two thousand and fifty-eight patients qualified for this study. Of these, 1058 patients had renal dysfunction. Patients with renal dysfunction were older, and had a higher prevalence of risk factors for atherosclerosis. Patients with moderate or severe renal dysfunction were less likely to be treated with beta blockers, angiotensin converting enzymes inhibitors, statins, or reperfusion therapies. Significantly worse outcomes were seen with lower eGFR in a stepwise fashion. The adjusted odds ratio of in-hospital death in patients with eGFR less than 30 ml/min was 5.3 (95% CI, 1.15-25.51, p=0.0383).

CONCLUSIONS: A low baseline eGFR in STEMI patients is an independent predictor of all major adverse cardiovascular outcomes, and a marker for less aggressive in-hospital therapy.