Significance of On-admission Impaired Estimated Glomerular Filtration Rate for the Assessment of Immediate Outcomes after Percutaneous Coronary Intervention

Abstract

Objectives: Impaired baseline estimated glomerular filtration rate (eGFR) has been associated with a heightened risk of major adverse clinical events (MACE) following percutaneous coronary intervention (PCI). Early recognition of renal dysfunction on admission can help optimize clinical decision-making and improve post-PCI outcomes. This study aimed to evaluate the prognostic significance of baseline eGFR among patients with acute myocardial infarction (AMI) and its impact on immediate in-hospital outcomes after PCI. Methodology: We enrolled adult AMI patients undergoing PCI and calculated their baseline eGFR (ml/min/1.73 m²). In-hospital MACE was recorded for all patients. Participants were stratified into three groups based on eGFR values: ≥60, 45–59, and <45 ml/min/1.73 m². Results: Among 296 patients (mean age: 56.8 ± 10.8 years; 87.5% male), eGFR distribution was as follows: ≥60 in 75.3%, 45–59 in 12.8%, and <45 in 11.8%. Overall, MACE occurred in 5.7% (17 patients). The incidence of MACE was significantly higher in patients with reduced eGFR (p=0.005), observed in 3.6% of patients with eGFR ≥ 60, 7.9% with eGFR 45–59, and 17.1% with eGFR <45. In multivariable analysis, Killip class III or IV and final TIMI (thrombolysis in myocardial infarction) flow < III were identified as independent predictors of in-hospital MACE (adjusted odds ratios [ORs]: 3.81 [95% confidence interval (CI): 1.01–14.36] and 7.17 [95% CI: 2.08–24.68], respectively), while eGFR did not reach statistical significance. Conclusion: Reduced baseline eGFR was associated with a higher incidence of in-hospital MACE following PCI in AMI patients. However, after adjusting for confounders, Killip class III or IV and suboptimal final TIMI flow were more robust independent predictors of immediate adverse outcomes. Methodology: We enrolled adult AMI patients undergoing PCI and calculated their baseline eGFR (ml/min/1.73 m²). In-hospital MACE was recorded for all patients. Participants were stratified into three groups based on eGFR values: ≥60, 45–59, and <45 ml/min/1.73 m². Results: Among 296 patients (mean age: 56.8 ± 10.8 years; 87.5% male), eGFR distribution was as follows: ≥60 in 75.3%, 45–59 in 12.8%, and <45 in 11.8%. Overall, MACE occurred in 5.7% (17 patients). The incidence of MACE was significantly higher in patients with reduced eGFR (p=0.005), observed in 3.6% of patients with eGFR ≥ 60, 7.9% with eGFR 45–59, and 17.1% with eGFR <45. In multivariable analysis, Killip class III or IV and final TIMI (thrombolysis in myocardial infarction) flow < III were identified as independent predictors of in-hospital MACE (adjusted odds ratios [ORs]: 3.81 [95% confidence interval (CI): 1.01–14.36] and 7.17 [95% CI: 2.08–24.68], respectively), while eGFR did not reach statistical significance. Conclusion: Reduced baseline eGFR was associated with a higher incidence of in-hospital MACE following PCI in AMI patients. However, after adjusting for confounders, Killip class III or IV and suboptimal final TIMI flow were more robust independent predictors of immediate adverse outcomes.