Journal of Invasive Cardiology

Admission serum creatinine ≥ 1.3 mg/dl (RR = 3.93, 95% CI: 1.13–6.84), discharge serum creatinine ≥ 1.3 mg/dl (RR = 2.01, 95% CI: 1.59–4.32), in-hospital worsened creatinine (RR = 2.84, 95% CI: 1.65–5.32), and number of narrowed coronary arteries (RR = 1.41, 95% CI: 1.07–1.68) were also independent predictors of poor myocardial perfusion detected by TMPG in STEMI patients undergoing primary PCI (Table 5).

Discussion

In our study, interactive relationships of admission serum creatinine and myocardial blood flow and long-term mortality in STEMI patients undergoing primary PCI were investigated, and were not systematically observed previously.1–11 The results demonstrated that in the setting of STEMI, patients with elevated admission creatinine levels had less complete ST-segment resolution, greater impairment of myocardial blood flow and more short- and long-term MACE and death after primary PCI. Elevated admission serum creatinine predicted poor myocardial flow independently, which predicted 1-year mortality in STEMI patients undergoing primary PCI despite age, admission creatinine level, Killip’s grades at presentation and number of narrowed coronary arteries.

Previous studies have shown that patients with baseline renal dysfunction have increased cardiovascular risk.22–26 In addition, they showed the existence of significant differences in baseline patient characteristics between those with and those without renal insufficiency, and suggested that poor outcomes in the renal insufficiency patients could be explained by the multitude of comorbid conditions and worse preprocedural cardiac status.