034 Creatinine clearance and adverse hospital outcomes in patients with myocardial infarction

IntroductionNormal renal function has been Shown in epidemiological studies and clinical trials to be an independent predictor of survival.ObjectiveTo determine whether creatinine clearance at the time of hospital admission is an independent predictor of hospital mortality and adverse outcomes in patients with ST-segment elevation myocardial infarction (STEMI).Patients231 patients hospitalized with STEMI in our institution between January 2005 to December 2006.In-hospital outcomes were compared for patients with creatinine clearance rates of > 60ml/min (normal renal function) and ≤60ml/min (moderate and severe Baseline Renal Dysfunction, BRD).ResultsPatients with BRD were older, were more likely to be women, and presented to with more comorbidites.Patients with BRD had presented more ischemic atrial fibrillation (p = 0.033).A greater number of patients with BRD had impaired left ventricle systolic performance, so this patients had more presented acute heart failure (p = 0.008), and cardiogenic shock (p = 0.017).Patients with worsened renal function had presented more mechanical complications:-free wall rupture and apical ventricular septal defect, in two separate cases, following anterior myocardial infarction, leading to immediate death of these two patients.-ischemic mitral regurgitation in one caseThe in hospital death rate of BRD patients was 6.6%, compared with 0.9% for non BRD patients.In comparison with patients with normal or minimally impaired renal function, patients with moderate renal dysfunction were seven times more likely to die (odds ratio 7, 09, 95% confidence interval 0.7 to 68) after adjustment for other potentially confounding Variables.The risk of bleeding episodes was increased in patients with worsened renal functionOnly one patient, with moderate renal dysfunction, had an ischemic stroke.ConclusionIn patients with ACS, creatinine clearance is an important independent predictor of hospital death