Effect of Late Revascularization of a Totally Occluded Coronary Artery After Myocardial Infarction on Mortality Rates in Patients With Renal Impairment

• Published in: The American journal of cardiology 2012-10, Vol.110 (7), p.954-960
• Main Authors: Hastings, Ramin S., MD, Hochman, Judith S., MD, Dzavik, Vladimir, MD, Lamas, Gervasio A., MD, Forman, Sandra A., MA, Schiele, Francois, MD, Michalis, Lampros K., MD, Nikas, Dimitris, MD, Jaroch, Joanna, MD, Reynolds, Harmony R., MD
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Coronary Angiography; Coronary heart disease; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - etiology; Coronary Stenosis - surgery; Female; Follow-Up Studies; Glomerular Filtration Rate; Heart; Heart attacks; Humans; Kidney diseases; Male; Medical sciences; Middle Aged; Mortality; Myocardial Infarction - complications; Myocardial Infarction - diagnosis; Myocardial Infarction - surgery; Myocardial Revascularization - methods; Myocarditis. Cardiomyopathies; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Prognosis; Renal failure; Renal Insufficiency - complications; Renal Insufficiency - diagnosis; Renal Insufficiency - mortality; Retrospective Studies; Risk Factors; Severity of Illness Index; Time Factors
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2012.05.024

Renal dysfunction is an independent predictor of cardiovascular events and a negative prognostic indicator after myocardial infarction (MI). Randomized data comparing percutaneous coronary intervention to medical therapy in patients with MI with renal insufficiency are needed. The Occluded Artery Trial (OAT) compared optimal medical therapy alone to percutaneous coronary intervention with optimal medical therapy in 2,201 high-risk patients with occluded infarct arteries >24 hours after MI with serum creatinine levels ≤2.5 mg/dl. The primary end point was a composite of death, MI, and class IV heart failure (HF). Analyses were carried out using estimated glomerular filtration rate (eGFR) as a continuous variable and by eGFR categories. Long-term follow-up data (maximum 9 years) were used for this analysis. Lower eGFR was associated with development of the primary outcome (6-year life-table rates of 16.9% for eGFR >90 ml/min/1.73 m2 , 19.2% for eGFR 60 to 89 ml/min/1.73 m2 , and 34.9% for eGFR