Influences of renal insufficiency on therapeutic schedule and prognosis in patients with acute myocardial ;infarction

ZHANG Guan-mao; LIU Xiao-dong; LIU Jie-wu; JIA Zhi-mei; JIA Zhi-jun

doi:10.3969/j.1674-4055.2014.02.20

Abstract：Objective To observe the influences of renal insufficiency on therapeutic schedule and prognosis in patients with acute myocardial infarction (AMI). Methods The patients (n=523) were chosen from Jun. 2011 to May 2012, and then divided into group A (with normal renal function or mild renal insufficiency, eGFR≥60mL/min.1.73m2) and group B (with medium or severe renal insufficiency, eGFR<60mL/min.1.73m2) according to eGFR level after calculating and estimating eGFR by using modified MDRD equation. The clinical characteristics, therapeutic schedule and prognosis were compared between 2 groups. Results The percentage of patients with complicating renal insufficiency was 71.7%(375/523) in group A and 28.3%(148/523) in group B. Compared with group A, patients were older and more were female, and proportion of complicating hypertension, diabetes, stroke and anemia was higher in group B (P<0.01). The percentage of patients accepted treatment of anticoagulation,β-receptor blocker, statins and ACEI/ARB drugs was significantly lower in group B than that in group A (P<0.01). The in-hospital mortality was significantly higher in group B than that in group A (P<0.01). The multi-factor regression analysis on in-hospital mortality showed that eGFR decrease was independently correlated to the increase of in-hospital mortality (OR=6.362, 95%CI:2.154-16.892, P<0.01) besides of age, female, complicating hypertension, complicating diabetes and PCI treatment. Conclusion The proportion of patients accepted AMI guideline-recommended treatment was lower in group B than that in group A during hospitalization, and in-hospital mortality was higher in group A. Medium or severe renal insufficiency is an independent risk factor of in-hospital mortality in AMI patients.