Reperfusion strategy for patients with renal dysfunction presenting with STEMI: which is better in the North African context?

M. Hassine; G. Cheniti; W. Selmi; M.B. Massoud; Z. Dridi; F. Betbout; H. Gamra

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Title: Reperfusion strategy for patients with renal dysfunction presenting with STEMI: which is better in the North African context?
Author(s): M. Hassine , G. Cheniti , W. Selmi , M.B. Massoud , Z. Dridi , F. Betbout , H. Gamra
Journal: Acta Cardiologica
Volume: 69 Issue: 3 Date: 2014
Pages: 245-251
DOI: 10.2143/AC.69.3.3027826

Abstract :
Background: Patients with renal insufficiency experience worse prognosis after STEMI. The current guidelines do not clearly draw specific strategies for patients with renal dysfunction (RD).
Aim: The aim of this study is to compare primary PCI (PPCI) and thrombolysis results as well as in-hospital mortality after successful reperfusion between the RD patients (RD+) and patients with normal renal function (RD-).
Methods: We retrospectively reviewed data for 1,388 patients admitted for STEMI between January 1995 and October 2011. Two groups were identified: PPCI (315 patients) and thrombolysis (379 patients). Ninety patients (13%) had RD defined by creatinine levels at admission > 130 μmol/l, they were equally treated by PPCI and thrombolysis.
Results: In the PPCI group, despite a similar pre-procedural TIMI flow (P = 0.82), TIMI III restoring was significantly lower in the RD+ group (78.6% vs. 91.8%, P = 0.013). Suboptimal result was also higher in the RD+ group (13.6% vs. 2.7%, P < 0.001), but ST regression after TIMI III achievement was similar in the 2 groups (P = 0.43), probably reflecting no microvascular damage. In the thrombolysis group, successful reperfusion was also significantly lower when RD exists (58% vs. 74%, P = 0.03). After successful reperfusion, RD+ patients experienced higher in-hospital mortality in the PPCI group (29% vs. 4.3%; P < 0.001), whereas mortality was similar in the thrombolysis group (3% vs. 0%, P = 0.42).
Conclusion: RD reduces either PPCI or thrombolysis success, with no proven microvascular damage after PPCI. In-hospital prognosis, however, is worse in the RD group only after successful PPCI, but not after successful streptokinase thrombolysis.