[Role of renal dysfunction and multifocal atherosclerosis in assessment of prognosis of patients presenting with ST-elevation acute coronary syndrome].

AIM: To assess incidence and severity of renal dysfunction as well as its prognostic value in patients with ST elevation myocardial infarction (STEMI) and multifocal atherosclerosis (MFA).

MATERIAL AND METHODS: We enrolled in this study 529 patients with STEMI in whom we estimated creatinine clearance rate (eGFR) and glomerular filtration rate (eCrCl) using Cockcroft-Gault equation and Modification of Diet in Renal Disease (MDRD) formula, respectively. Duplex ultrasonography of lower extremity and extracranial arteries was performed in 423 patients on day 5-10 of hospitalization. Signs of MFA were found in 95% of patients. Hospital mortality was 10.9%. One year survival of 397 patients was assessed by the telephone contacts. Thirty nine patients (9.8%) died.

RESULTS: GFR in 35.5% of patients was 30-60, and in 4.9% - less than 30 ml/min/1.73 m2. At the same time 29.5% of patients had CCr 30 - 60, and 3.0% - less than 30 ml/min. Progressive decreases of eCCr and eGFR were observed in patients with incipient MFA (stenosis <30%); relationship between MFA and eGRF was more close. Presence of renal dysfunction in patients with STEACS and MFA was associated elevation of both hospital and 1 year mortality.

CONCLUSION: Any manifestation of peripheral atherosclerosis and impairment of renal function should be considered as independent predictors of cardiovascular events in patients after STEMI.