Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju 501-757, South Korea.
BMC Nephrol. 2012 Sep 11;13:110. doi: 10.1186/1471-2369-13-110.
The clinical outcomes of ST-segment elevation myocardial infarction (STEMI) are poor in patients with renal insufficiency. This study investigated changes in the likelihood that patients received optimal medical care throughout the entire process of myocardial infarction management, on the basis of their glomerular filtration rate (GFR).
This study analyzed 7,679 patients (age, 63 ± 13 years; men 73.6%) who had STEMI and were enrolled in the Korea Acute Myocardial Infarction Registry (KAMIR) from November 2005 to August 2008. The study subjects were divided into 5 groups corresponding to strata used to define chronic kidney disease stages.
Patients with lower GFR were less likely to present with typical chest pain. The average symptom-to-door time, door-to-balloon time, and symptom-to-balloon time were longer with lower GFR than higher GFR. Primary reperfusion therapy was performed less frequently and the results of reperfusion therapy were poorer in patients with renal insufficiency; these patients were less likely to receive adjunctive medical treatment, such as treatment with aspirin, clopidogrel, β-blocker, angiotensin-converting enzyme (ACE) inhibitor/angiotensin-receptor blocker (ARB), or statin, during hospitalization and at discharge. Patients who received less intense medical therapy had worse clinical outcomes than those who received more intense medical therapy.
Patients with STEMI and renal insufficiency had less chance of receiving optimal medical care throughout the entire process of MI management, which may contribute to worse outcomes in these patients.
肾功能不全的 ST 段抬高型心肌梗死（STEMI）患者临床预后较差。本研究基于肾小球滤过率（GFR），调查了在心肌梗死管理的整个过程中，患者接受最佳药物治疗的可能性变化。
本研究分析了 2005 年 11 月至 2008 年 8 月期间韩国急性心肌梗死注册研究（KAMIR）中 7679 名（年龄 63±13 岁；男性 73.6%）STEMI 患者。研究对象被分为 5 组，对应于定义慢性肾脏病分期的分层。
GFR 较低的患者不太可能出现典型胸痛。GFR 较低的患者平均症状至门时间、门至球囊时间和症状至球囊时间较长。与肾功能正常者相比，肾功能不全患者接受直接再灌注治疗的频率较低，再灌注治疗效果较差；这些患者在住院和出院期间不太可能接受辅助药物治疗，如阿司匹林、氯吡格雷、β受体阻滞剂、血管紧张素转换酶（ACE）抑制剂/血管紧张素受体阻滞剂（ARB）或他汀类药物治疗。接受药物治疗强度较低的患者临床结局较接受药物治疗强度较高的患者差。
STEMI 合并肾功能不全的患者在心肌梗死管理的整个过程中接受最佳药物治疗的机会较少，这可能导致这些患者的预后较差。
