Pre-procedure Creatinine as a Predictor of Mortality among STEMI patients Undergoing PCI: An Observational Study from a Tertiary Care Center In a LMIC

Abstract

Objectives: Primary percutaneous coronary intervention (PCI) is the preferred treatment for ST-elevation myocardial infarction (STEMI), but in-hospital mortality remains a concern, especially in patients with renal impairment. Pre-procedure creatinine (PreProcCreat) has been identified as a potential predictor of mortality, yet its role in risk stratification remains underexplored, particularly in lower-middle-income countries (LMICs). Methodology: This retrospective observational study analyzed 3,189 STEMI patients who underwent PCI at a tertiary cardiac center in Pakistan from September 2022 to February 2023. PreProcCreat levels were evaluated as a predictor of in-hospital mortality using receiver operating characteristic (ROC) curve analysis and multivariate logistic regression. Other variables, including fluoroscopy time, contrast volume, door-to-balloon time, weight, and BMI, were also assessed. Results: In-hospital mortality was 5.87% (n = 191). PreProcCreat showed a significant association with mortality (AUC = 0.708, p < 0.0001), with a cutoff of 1 mg/dL providing 65.93% sensitivity and 69.56% specificity. Each 1-unit increase in creatinine was associated with a 2.54-fold increase in mortality risk. Fluoroscopy time (AUC = 0.572) and door-to-balloon time (AUC = 0.603) had moderate associations with mortality, while weight, BMI, and contrast volume demonstrated weaker correlations. Conclusion: PreProcCreat is a strong prognostic marker for mortality in STEMI patients undergoing PCI, with a 1 mg/dL threshold effectively distinguishing high- and low-risk groups. While other factors contribute to risk stratification, aggressive AMI treatment in renal-impaired patients may not always reduce mortality. Future research should develop multi-factor risk algorithms to improve patient outcomes.