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J Am Coll Cardiol, 2003; 42:1535-1543, doi:10.1016/j.jacc.2003.06.001
© 2003 by the American College of Cardiology Foundation
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CLINICAL RESEARCH

Association of creatinine and creatinine clearance on presentation in acute myocardial infarction with subsequent mortality

C. Michael Gibson, MS, MD*,*, Duane S. Pinto, MD{dagger}, Sabina A. Murphy, MPH*, David A. Morrow, MD, MPH*, Hans-Peter Hobbach, MD{ddagger}, Stephen D. Wiviott, MD*, Robert P. Giugliano, MD, SM*, Christopher P. Cannon, MD*, Elliott M. Antman, MD*, Eugene Braunwald, MD* TIMI Study Group

* TIMI Study Chairman's Office, Department of Medicine, Brigham and Women's Hospital, Boston, USA
{dagger} Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
{ddagger} St. Marienkrankenhaus Siegen, Siegen, Germany

Manuscript received April 18, 2003; revised manuscript received June 4, 2003, accepted June 9, 2003.

* Reprint requests and correspondence: Dr. C. Michael Gibson, Director TIMI Data Coordinating Center, 350 Longwood Avenue, First Floor, Boston Massachusetts 02115, USA.
mgibson{at}timi.org

OBJECTIVES: We hypothesized that impaired renal function would also be associated with poorer clinical outcomes among patients with ST-segment elevation myocardial infarction (STEMI) treated with fibrinolysis.

BACKGROUND: Previous studies have demonstrated that impaired renal function is associated with poorer clinical outcomes in the setting of unstable angina and non-STEMI and after percutaneous coronary intervention.

METHODS: Data were drawn from the Thrombolysis In Myocardial Infarction (TIMI)-10, TIMI-14, and Intravenous nPA for the Treatment of Infarcting Myocardium Early (InTIME-II) trials.

RESULTS: Within each TIMI risk score (TRS) for STEMI category (0 to 2, 3 to 4, ≥5), 30-day mortality increased stepwise among patients with normal (creatinine [Cr] ≤1.2 mg/dl), mildly (Cr >1.2 to 2 mg/dl), and severely (Cr >2.0 mg/dl) impaired renal function (p < 0.001) and in patients with normal (creatinine clearance [CrCl] ≥90 ml/min), mildly (60 to <90 ml/min), moderately (30 to <60 ml/min), and severely (<30 ml/min) impaired CrCl (p < 0.001). Impaired renal function was associated with increased mortality after adjusting for previously identified correlates of mortality (using Cr: odds ratio [OR] for mild impairment 1.52, 95% confidence interval [CI] 1.30 to 1.77, p < 0.001; OR for severe impairment 3.73, 95% CI 2.55 to 5.45, p < 0.001; using CrCl: OR for mild impairment 1.38, 95% CI 1.10 to 1.73, p = 0.006; OR for moderate impairment 2.06, 95% CI 1.59 to 2.66, p < 0.001; OR for severe impairment 3.81, 95% CI 2.57 to 5.65, p < 0.001).

CONCLUSIONS: In the setting of STEMI, elevated Cr and/or impaired CrCl on presentation is associated with increased mortality, independent of other conventional risk factors and TRS. This association does not appear to be mediated by reduced fibrinolytic efficacy among patients with impaired renal function or by the presence of congestive heart failure on presentation.

Abbreviations and Acronyms
  CHF = congestive heart failure
  Cr(Cl) = creatinine (clearance)
  CTFC = corrected TIMI frame count
  ICH = intracranial hemorrhage
  MI = myocardial infarction
  OR = odds ratio
  PCI = percutaneous coronary intervention
  STEMI = ST-segment elevation myocardial infarction
  TIMI = Thrombolysis In Myocardial Infarction
  TRS = TIMI risk score




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