Gender differences in the prognostic impact of chronic kidney disease in patients with left ventricular systolic dysfunction following ST elevation myocardial infarction treated with primary percutaneous coronary intervention.

BACKGROUND/AIM: Renal function potentially has different prognostic impact in men and women with acute myocardial infarction. The aim of this study was to evaluate the prognostic impact of chronic kidney disease (CKD) on five-year all-cause mortality in men and women with left ventricular systolic dysfunction (LVSD) following ST elevation myocardial infarction (STEMI).

METHOD: We included 348 consecutive STEMI patients who were treated with primary percutaneous coronary intervention (pPCI) and had a left ventricular ejection fraction < 40%. CKD was defined as baseline creatinine clearance (CrCl) < 60 ml/min. Patients with cardiogenic shock at admission were excluded.

RESULTS

Among analyzed patients, 104 patients (29.8%) were women, and 244 patients (70.1%) were men. Compared with male patients, female patients were older. Females were more likely to have previous angina and hypertension. CKD was more common in women compared with men (54.8% vs. 22.5%, p<0.001). Female gender and older age were independent predictors of CKD. No significant difference in five-year all-cause mortality was between men and women (27.8% vs. 23.3%, p=0.370). In a Cox regression model (adjustments were made for age, Killip class at admission, post-procedural flow TIMI<3, left main stenosis and women with diabetes), CKD remained an independent predictor of five-year all-cause mortality in men (HR 2.2; 95% CI 1.22-3.3, p=0.007).

CONCLUSIONS

Although pre-terminal CKD was more frequently noted in women, it was an independent predictor of five-year mortality exclusively in men. Different prognostic significance of CKD between sexes indicates that renal function must be considered in the prognosis of men and women following acute myocardial infarction.