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Reperfusion strategy and mortality in ST-elevation myocardial infarction among patients with and without impaired renal function.

Publication ,  Journal Article
Chan, MY; Becker, RC; Sim, L-L; Tan, V; Lee, C-H; Low, AFH; Teo, S-G; Ng, K-S; Tan, H-C; Yeo, T-C
Published in: Annals of the Academy of Medicine, Singapore
March 2010

Several randomised controlled trials have demonstrated better outcomes with primary percutaneous coronary intervention (PCI) over fibrinolytic therapy in the treatment of patients with ST-segment elevation myocardial infarction (STEMI) and normal renal function. Whether this benefit extends to patients with impaired renal function is uncertain.We studied 1672 patients with STEMI within 12 hours of symptom onset who were admitted to 2 major public hospitals in Singapore from 2000 to 2002. All patients received either upfront fibrinolytic or PCI as determined by the attending cardiologist. Serum creatinine was measured on admission and the glomerular filtration rate (GFR) was determined using the Modification of Diet in Renal Disease equation. The impact of reperfusion strategy on 30-ay mortality was then determined for patients with GFR > or =60 mL min-(1) 1.73 m-(2) and GFR <60 mL min-(1) 1.73 m-(2).The mean age was 56 +/- 12 years (85% male) and mean GFR was 81 +/- 30 mL min-(1) 1.73 m-(2). Unadjusted 30-day mortality rates for fibrinolytic-treated vs primary PCI-treated patients were 29.4% vs 17.9%, P <0.05, in the impaired renal function group and 5.4% vs 3.1%, P <0.05, in the normal renal function group. After adjusting for covariates, primary PCI was associated with a significantly lower mortality in the normal renal function group [odds ratio (OR), 0.41; 95% confidence interval (CI), 0.19-0.89] but not in the impaired renal function group [OR, 0.70; 95% CI, 0.31-1.60].Primary PCI was associated with improved 30-day survival among patients with normal renal function but not among those with impaired renal function. Randomised trials are needed to study the relative efficacy of both reperfusion strategies in patients with impaired renal function.

Duke Scholars

Published In

Annals of the Academy of Medicine, Singapore

EISSN

2972-4066

ISSN

0304-4602

Publication Date

March 2010

Volume

39

Issue

3

Start / End Page

179 / 184

Related Subject Headings

  • Survival Analysis
  • Retrospective Studies
  • Renal Insufficiency, Chronic
  • Registries
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Glomerular Filtration Rate
  • General & Internal Medicine
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Chan, M. Y., Becker, R. C., Sim, L.-L., Tan, V., Lee, C.-H., Low, A. F. H., … Yeo, T.-C. (2010). Reperfusion strategy and mortality in ST-elevation myocardial infarction among patients with and without impaired renal function. Annals of the Academy of Medicine, Singapore, 39(3), 179–184.
Chan, Mark Y., Richard C. Becker, Ling-Ling Sim, Virlynn Tan, Chi-Hang Lee, Adrian F. H. Low, Swee-Guan Teo, Kheng-Siang Ng, Huay-Cheem Tan, and Tiong-Cheng Yeo. “Reperfusion strategy and mortality in ST-elevation myocardial infarction among patients with and without impaired renal function.Annals of the Academy of Medicine, Singapore 39, no. 3 (March 2010): 179–84.
Chan MY, Becker RC, Sim L-L, Tan V, Lee C-H, Low AFH, et al. Reperfusion strategy and mortality in ST-elevation myocardial infarction among patients with and without impaired renal function. Annals of the Academy of Medicine, Singapore. 2010 Mar;39(3):179–84.
Chan, Mark Y., et al. “Reperfusion strategy and mortality in ST-elevation myocardial infarction among patients with and without impaired renal function.Annals of the Academy of Medicine, Singapore, vol. 39, no. 3, Mar. 2010, pp. 179–84.
Chan MY, Becker RC, Sim L-L, Tan V, Lee C-H, Low AFH, Teo S-G, Ng K-S, Tan H-C, Yeo T-C. Reperfusion strategy and mortality in ST-elevation myocardial infarction among patients with and without impaired renal function. Annals of the Academy of Medicine, Singapore. 2010 Mar;39(3):179–184.

Published In

Annals of the Academy of Medicine, Singapore

EISSN

2972-4066

ISSN

0304-4602

Publication Date

March 2010

Volume

39

Issue

3

Start / End Page

179 / 184

Related Subject Headings

  • Survival Analysis
  • Retrospective Studies
  • Renal Insufficiency, Chronic
  • Registries
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Glomerular Filtration Rate
  • General & Internal Medicine