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Prognostic impact of renal dysfunction on long-term mortality in patients with preserved, moderately impaired and severely impaired left ventricular systolic function following myocardial infarction [Anatol J Cardiol]
Anatol J Cardiol. Ahead of Print: AJC-47701 | DOI: 10.14744/AnatolJCardiol.2018.47701  

Prognostic impact of renal dysfunction on long-term mortality in patients with preserved, moderately impaired and severely impaired left ventricular systolic function following myocardial infarction

Lidija Savic1, Igor Mrdovic1, Milika Asanin1, Sanja Stankovic2, Gordana Krljanac1, Ratko Lasica1
1Clinical Centre Of Serbia, Emergency Hospital, Coronary Care Unit & Cardiology Clinic, Belgrade, Serbia
2Center For Medical Biochemistry, Emergency Hospital, Clinical Center Of Serbia, Belgrade, Serbia

Background/aim: The aim of this study was to investigate and compare the prognostic impact of renal dysfunction (RD) at admission in patients with preserved, moderately and severely impaired left ventricular systolic function following ST-elevation myocardial infarction (STEMI).
Method: we included 2436 STEMI patients treated with primary PCI. Patients presenting with cardiogenic shock and patients on hemodyalisis were excluded. According to left ventricular ejection fraction (EF), patients were divided in three groups: preserved left ventricular systolic function-EF>50%, moderately impaired -EF=40-50% and severely impaired left ventricular systolic function-EF<40%. RD was defined as estimated glomerular filtration rate (eGFR)<60ml/min/m2 at admission. The follow-up period was 6 years.
Results: Preserved, moderately and severely impaired systolic function were found in 741(30.5%), 1367(56.1%) and 328(13.4%) patients, respectively. RD was present in 105 (14.2%) patients with preserved systolic function, 247(18.1%) patients with moderately impaired and 120(36.5%) patients with severely impaired systolic function. Regardless of the presence of RD, 6-year mortality rates in patients with preserved, moderately and severely impaired systolic function were 2.7%, 5.2% and 31.1% respectively. Within each LVEF group, patients with RD had a worse outcome, both in the short- and long term. In Cox regression model RD remained an independent predictor of 6-year mortality in patients with moderately (HR 2.52, 95%CI 1.54-3.78) and severely impaired systolic function (HR 2.84, 95%CI 1.68-5.34), but not in patients with preserved left ventricular systolic function (HR 0,59, 95%CI 0,14-1,41).
Conclusion: Although patients with RD had higher 6-year mortallity following STEMI regardless of the LVEF, RD at admission remained a strong independent predictor for 6-year mortality only in patients with moderately and severely impaired left ventricular systolic function.

Keywords: renal dysfunction, left ventricular systolic function, prognosis




Corresponding Author: Lidija Savic, Serbia


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