scholarly journals Case Report: Successful primary percutaneous coronary intervention in octogenarian with acute-on-chronic kidney disease and total atrioventricular block after acute myocardial infarction

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 267
Author(s):  
Andrianto Andrianto ◽  
Ni Putu Anggun Laksmi ◽  
Rio Herdyanto
Keyword(s):  
Myocardial Infarction ◽  
Chronic Kidney Disease ◽  
Percutaneous Coronary Intervention ◽  
Renal Function ◽  
Kidney Disease ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Percutaneous Coronary ◽  
Total Atrioventricular Block

Myocardial infarction (MI) is frequently complicated by the worsening of renal function. Undergoing primary percutaneous coronary intervention (PCI) becomes crucial to a patient with ST-segment elevation myocardial infarction (STEMI). With appropriate management of MI, acute-on-chronic kidney disease (ACKD) requiring dialysis post-MI remains an important clinical predictor of elevated in-hospital mortality among patients with MI.  In this study, we reported an octogenarian patient suffering from STEMI with ACKD and total atrioventricular block (TAVB). She underwent insertion of a temporary pacemaker and primary PCI. Renal function was improved after dialysis by decreasing the amount of serum creatinine from 8.1 mg/dL at admission to 1.05 mg/dL after primary PCI and dialysis. Primary PCI should still be considered for patients with acute MI, even though these patients have kidney disease, to save the heart muscle and even indirectly improve the kidney function itself.

scholarly journals Clinical characteristics and long-term mortality of patients with midrange ejection fraction undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Vratonjic ◽  
D Milasinovic ◽  
M Asanin ◽  
V Vukcevic ◽  
S Zaharijev ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Ejection Fraction ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Long Term Mortality

Abstract Background Previous studies associated midrange ejection fraction (mrEF) with impaired prognosis in patients with ST-elevation myocardial infarction (STEMI). Purpose Our aim was to assess clinical profile and short- and long-term mortality of patients with mrEF after STEMI treated with primary percutaneous coronary intervention (PCI). Methods This analysis included 8148 patients admitted for primary PCI during 2009–2019, from a high-volume tertiary center, for whom echocardiographic parameters obtained during index hospitalization were available. Midrange EF was defined as 40–49%. Adjusted Cox regression models were used to assess 30-day and 5-year mortality hazard of mrEF, with the reference category being preserved EF (>50%). Results mrEF was present in 29.8% (n=2 427), whereas low ejection fraction (EF<40%) was documented in 24.7% of patients (n=2 016). mrEF was associated with a higher baseline risk as compared with preserved EF patients, but lower when compared with EF<40%, in terms of prior MI (14.5% in mrEF vs. 9.9% in preserved EF vs. 24.2% in low EF, p<0.001), history of diabetes (26.5% vs. 21.2% vs. 30.0%, p<0.001), presence of Killip 2–4 on admission (15.7% vs. 6.9% vs. 26.5%, p<0.001) and median age (61 vs. 59 vs. 64 years, p<0.001). At 30 days, mortality was comparable in mrEF vs. preserved EF group, while it was significantly higher in the low EF group (2.7% vs. 1.6% vs. 9.4%, respectively, p<0.001). At 5 years, mrEF patients had higher crude mortality rate as compared with preserved EF, but lower in comparison with low EF (25.1% vs. 17.0% vs. 48.7%, p<0.001) (Figure). After adjusting for the observed baseline differences mrEF was independently associated with increased mortality at 5 years (HR 1.283, 95% CI: 1.093–1.505, p=0.002), but not at 30 days (HR 1.444, 95% CI: 0.961–2.171, p<0.001). Conclusion Patients with mrEF after primary PCI for STEMI have a distinct baseline clinical risk profile, as compared with patients with reduced (<40%) and preserved (≥50%) EF. Importantly, mrEF did not have a significant impact on short-term mortality following STEMI, but it did independently predict the risk of 5-year mortality. Funding Acknowledgement Type of funding source: None

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