Impact of the combined presence of left ventricular systolic and renal dysfunction on the 5-year outcome after ST-elevation myocardial infarction

Lidija Savić; Igor Mrdović; Milika Ašanin; Sanja Stanković; Dragan Matić; Gordana Krljanac; Ratko Lasica

doi:10.2298/5772

Lidija Savić Coronary Care Unit, Cardiology Clinic and Emergence Hospital, Center for Medical Biochemistry, Emergency Hospital, Clinical Center of Serbia, Belgrade, Serbia
Igor Mrdović Coronary Care Unit, Cardiology Clinic and Emergence Hospital, Center for Medical Biochemistry, Emergency Hospital, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Milika Ašanin Coronary Care Unit, Cardiology Clinic and Emergence Hospital, Center for Medical Biochemistry, Emergency Hospital, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Sanja Stanković Center for Medical Biochemistry, Emergency Hospital, Clinical Center of Serbia, Belgrade, Serbia
Dragan Matić Coronary Care Unit Emergency Hospital, Clinical Center of Serbia, Belgrade, Serbia
Gordana Krljanac Coronary Care Unit, Cardiology Clinic and Emergence Hospital, Center for Medical Biochemistry, Emergency Hospital, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Ratko Lasica Coronary Care Unit, Emergency Hospital, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia

DOI: https://doi.org/10.2298/5772

Keywords: myocardial infarction, comorbidity, ventricular dysfunction, left, angioplasty, baloon, mortality, prognosis,

Abstract

Background/Aim. The coincidence of left ventricular systolic dysfunction (LVSD) and renal dysfunction (RD) is a strong independent predictor of adverse events in the short-term and mid-term follow-ups of patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). The aim of this study was primarily to assess the prognostic impact of the LVSD-RD combination on the 5-year all-cause mortality in patients with STEMI treated with pPCI, as well as to assess the prognostic impact of the LVSD-RD combination on the occurrence of major adverse cardiovascular events (MACEs: cardiovascular death, reinfarction, stroke and target vessel revascularization) in these patients. Methods. We analyzed 951 patients divided into 4 groups according to the presence of LVSD (ejection fraction < 40%) and/or baseline RD (creatinine clearance < 60 mL/min): group I (no LVSD, no RD); group II (LVSD, no RD); group III (RD, no LVSD); group IV (LVSD+RD). Results. The 5-year mortality rates were 2.3%, 17.6%, 11.7% and 38.3%, while the 5-year MACE rates were 8.8%, 28.4%, 18.3% and 44.4% in the groups I, II, III and IV, respectively (p < 0.001). The highest percentage of lethal outcomes and MACE was registered in the first year of follow-up in all the groups. The 1-year landmark analysis confirmed that the patients with LVSD-RD combination had the highest percentage of lethal outcomes in the period of 1 to 5 years (p = 0.028). There was a strong trend toward the significance in the occurrence of MACE among the analyzed groups in the period of 1 to 5 years (p = 0.085). In the Cox regression model the LVSD-RD combination was a strong independent predictor of 5-year mortality and the occurrence of MACE: mortality hazard ratio (HR) 4.5 (95%CI 1.9–10.8); MACE HR 2.5 (95%CI 1.4–4.5). Conclusion. The strong negative independent prognostic impact of the LVSD-RD combination persisted in the long-term follow-up of the patients with STEMI treated with pPCI.

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