الفهرس 
Evaluation of Renal FunctionOnly 14 pages are availabe for public view
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Abstract
S TEMI represents an important cause of morbidity and mortality worldwide. The prevalence of CKD among patients with STEMI is high. Myocardial infarction is the main cause of death in CKD patients. This study was conducted at cardiology department Ain Shams university hospitals to evaluate the impact of chronic kidney disease on the interventional outcome in STEMI patients treated by primary PCI. 100 patients who were admitted to Ain Shams university hospitals with STEMI and treated with primary PCI were enrolled starting from April 2015 to November 2015 The patients were subjected to history & examination regarding demographic factors, traditional risk factors for CAD, past history of CAD including previous ACS or revascularization. The patients’ vital data and initial killip class and the patients’ weight were recorded. ECG was done on admission for STEMI localization and within 4hours after the procedure to evaluate procedural success. Full laboratory investigations were done with special attention to serum creatinine. Interventional data collected included the culprit vessel, the severity of coronary artery disease assessed by Gensini score, type of intervention performed, type of stent used, occurrence of complications and assessment of epicardial coronary artery flow and myocardial reperfusion initially, after stent deployment and at the end of the procedure by TIMI flow and MBG respectively. Rate of procedural success was defined by both angiographic criteria (TIMI III flow with MBG ≥2 at the end of the procedure) & ECG criteria (Resolution of ≥70% of ST elevation within 4hrs of the procedure) Patients were stratified according to CrCl (Calculated by CG formula) and eGFR (calculated by MDRD formula) into normal renal functions group, moderate renal dysfunction group and severe renal dysfunction group. The majority of patients were males with mean age of 57 years. 64% were current smokers while 44 patients had HTN 34 patients had DM.24 patients had history of prior ACS while 8 patients had a history of prior PCI. Only 2 patients had prior CABG. 7 patients initial Killip was ≥3. 63 patients had anterior STEMI. Thrombus aspiration was done in 21 patients. 94 patients received stents of which 60% had direct stenting while DES were used in 16 patients direct stenting was done in 60 patients, while it was proceeded by thrombus aspiration in 16 patients, by PTCA in 17 patients and by both in one patient. DES were used in 16 patients Patients were divided according to CrCl into 2 groups: normal renal function group including 61 patients and CKD group including 39 patients which was further subdivided into moderate renal dysfunction group including 27patinets and Severe renal dysfunction group including 12 patients. CKD patients were older with higher proportion of females and higher prevalence of diabetes and hypertension and less likely to have a family history of coronary artery disease. They experienced prior ACS and underwent surgical revascularization more frequently. Vital data as well as initial Killip class didn’t differ between the studied groups. There was a non-significant trend towards a longer pain to door time in CKD group. The culprit vessel was the LAD in over 60% of patients. The severity of CAD increased as renal function declined indicated by increment in the mean Gensini Score with decrements in renal functions. The type of intervention performed didn’t differ significantly between the compared groups. Following stent deployment CKD patients showed a significantly higher incidence of no reflow. Final TIMI 3 flow was recorded in 75% of normal renal function group and 43% of CKD group however there was no significant difference between the CKD subgroups. CKD group showed a significantly lower MBG compared to normal renal function group (MBG≥2 in 59% & 88.5% respectively). The rate of successful reperfusion assessed angiographically was achieved in 88.5% of normal renal function group while it was 59% in CKD group. The difference between subgroups in the rate of successful reperfusion was not significant. The rate of successful reperfusion assessed by ST segment resolution within 4 hours after the procedure was significantly higher in Normal renal function group when compared to the CKD group however there was no significant difference on comparing both moderate renal dysfunction group with severe renal dysfunction group. On using univariate analysis there were three factors significantly affecting rate of successful reperfusion: DM, Gensini score and reduced CrCl. After building final logistic regression model only reduced CrCl was independently and inversely related to successful reperfusion (Adjusted OR 0.186, 95% CI:0.068-0.513,P=0.001). When patients were stratified into groups by eGFR the groups showed similarities to CrCl groups regarding demographic, clinical and Interventional data. Also a significant reduction in the rate of procedural success assessed by angiographic and electrocardiographic criteria was found when CKD group was compared to normal renal function group. Multivariate analysis confirmed the significant inverse relationship between reduced eGFR and suboptimal reperfusion. After adjustment of covariates both CG formula and MDRD formula had equal power of predicting suboptimal reperfusion.