Reperfusion strategy for patients with renal dysfunction presenting with STEMI - 25/12/18
Résumé |
Background |
Patients with renal insufficiency experience worse prognosis after STEMI. The current guidelines do not clearly draw specific strategies for patients with renal dysfunction (RD).
Aim |
The aim of this study is to compare primary PCI (PPCI) and thrombolysis results as well as in-hospital mortality after successful reperfusion between the RD patients (RD+) and patients with normal renal function (RD−).
Methods |
We retrospectively reviewed data for 1785 patients admitted for STEMI between January 2007 and October 2017. Two groups were identified: PPCI (624 patients) and thrombolysis (679 patients). Hundred and twenty-two patients had RD defined by creatinine levels at admission>130 umol/L, they were equally treated by PPCI and thrombolysis.
Results |
In the PPCI group, despite a similar pre-procedural TIMI flow (P=0.54), TIMI III restoring was significantly lower in the RD+ group (74.1% vs. 93.2%, p=0.01). Suboptimal result was also higher in the RD+ group (15.6% vs. 3.2%, P<0.001), but ST regression after TIMI III achievement was similar in the 2 groups (P=0.62), probably reflecting no microvascular damage. In the thrombolysis group, successful reperfusion was also significantly lower when RD exists (51% vs. 78%, P=0.02). After successful reperfusion, RD+ patients experienced higher in-hospital mortality in the PPCI group (11.2% vs. 3.1%; P<0.001), whereas mortality was similar in the thrombolysis group (3.1% vs. 0.3%, P=0.75).
Conclusion |
RD reduces either PPCI or thrombolysis success, with no proven microvascular damage after PPCI. In-hospital prognosis, however, is worse in the RD group only after successful PPCI, but not after successful streptokinase thrombolysis.
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Vol 11 - N° 1
P. 22 - janvier 2019 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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