Impact of renal function on treatment strategies and clinical outcomes in acute myocardial infarction patients with multivessel disease.

OBJECTIVE

The impact of renal function on revascularization outcomes in patients with acute myocardial infarction and multivessel disease remains unclear. This study compared long-term outcomes of complete (CR) and incomplete revascularization (IR) in patients with estimated glomerular filtration rate (eGFR) ≥60 or <60 mL/min/1.73 m2

METHODS

Using data from the Korea Acute Myocardial Infarction Registry-National Institute of Health, 5962 patients (mean age: 65.4 ± 12.1 years; 4389 men) were categorized by renal function into Group I (eGFR ≥60, n = 4689) and Group II (eGFR <60, n = 1273). Each group was divided into CR (IA, IIA) and IR (IB, IIB) subgroups. The primary end point was the incidence of major adverse cardiac events (MACEs), a composite of all-cause death, myocardial infarction, and repeat revascularization, assessed over a 3-year follow-up.

RESULTS

MACEs were more frequent in Group II than Group I (41.5% vs. 19.4%, p < 0.001). In Group I, CR reduced MACEs compared with IR (16.7% vs. 22.6%, p < 0.001). However, no significant difference was found between CR and IR in Group II (p = 0.118). Key predictors of MACEs included advanced age, diabetes, prior myocardial infarction, ST-elevation myocardial infarction, and IR.

CONCLUSION

CR improved outcomes in patients with eGFR ≥60, whereas no difference was observed between CR and IR in those with eGFR <60. Therefore, IR may be a viable option for patients with reduced renal function.