Glomerular filtration rate (GFR) during and after STEMI: a single-centre, methodological study comparing estimated and measured GFR

Impact of baseline estimated glomerular filtration rate on inhospital outcomes of patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: A China acute myocardial infarction registry study

OBJECTIVE

To explore the relationship between inhospital outcomes and different estimated glomerular filtration rates (eGFRs) and determine an optimal eGFR cutoff value for predicting risk in patients with renal insufficiency (RI).

BACKGROUND

RI is a predictor of poor prognosis in patients with myocardial infarction undergoing primary percutaneous coronary intervention (PCI). However, the cutoff value of the eGFR is questionable.

METHODS

We included 10,240 patients with ST segment elevation myocardial infarction (STEMI) undergoing primary PCI from January 2013 to January 2016 who participated in the China Acute Myocardial Infarction registry. RI was defined as eGFR <60 mL/min/1.73 m² . Patients were stratified into five eGFR groups to determine the optimal cutoff value: <30, 30-45, 45-60, 60-90, and > 90 mL/min/1.73 m² .

RESULTS

Overall, 1,112 (10.9%) patients had eGFR <60 mL/min/1.73 m² . Patients with eGFR<60 mL/min/1.73 m² had a significantly higher incidence of all-cause death and major adverse cardiovascular and cerebrovascular events (MACCEs) than those with eGFR >60 mL/min/1.73 m² . Occurrence trend test analysis revealed that the incidence of inhospital all-cause death and MACCEs increased as the eGFR decreased. In logistic multivariate-adjusted analysis, eGFR <45 mL/min/1.73 m² was associated with a higher incidence of all-cause death and MACCEs than eGFR >90 mL/min/1.73 m² .

CONCLUSIONS

RI is common among patients with STEMI undergoing primary PCI. A low eGFR is an indicator of worse inhospital prognosis. We suggest an eGFR cutoff value of 45 mL/min/1.73 m² to predict inhospital deaths and MACCEs.

Kidney function is associated with short-term, mid-term and long-term clinical outcome after coronary angiography and intervention

BACKGROUND

Patients with kidney dysfunction are at risk of developing ischaemic heart disease. We investigated the association between eGFR and early-, mid- and long-term clinical outcome in patients undergoing coronary angiography and intervention.

METHODS

Retrospective study on 4968 patients with complete data on eGFR, 65% male and aged 32-80 years, admitted to Danderyd University Hospital, Stockholm, Sweden for coronary angiography and intervention from 2006 to 2008. Data were censored at 0-30 days, 31-365 days and 366-1825 days of follow-up.

RESULTS

Baseline eGFR was strongly associated with all-cause mortality at all three time periods studied with each 10 ml/min per 1.73 m² increase in eGFR being associated with a ∼30% (p < .001), 25% (p = .002) and 20% (p < .001) decrease in all-cause mortality at 30, 365 and 1825 days respectively. Each 10 ml/min per 1.73 m² increase in eGFR was associated with a ∼21% (p < .001) decrease in re-hospitalisation for MI at 365 days and a 6% decrease (p = .03) at day 30 for re-vascularisation.

CONCLUSIONS

We report a strong association between kidney function and all-cause mortality at both early, mid- and long-term follow-up in patients undergoing coronary angiography and intervention, with eGFR significantly associated with MI-related mortality after one month of follow-up. Kidney function was also shown to be associated with risk for re-vascularisation at one month, indicating mostly procedural-related risk and with new MI at mid-term follow-up. Further research is warranted to explore the mechanisms linking kidney function and cardiovascular disease to improve both the short- and long-term care of these patients.

Adsorption and removal of strontium in aqueous solution by synthetic hydroxyapatite

Hydroxyapatite (HAP) is a main mineral constituent of bone and tooth and has an outstanding biocompatibility. HAP is a possible sorbent for heavy metals in wastewater due to its high adsorption capacity and low water solubility. We developed a removal system of ⁹⁰Sr from aqueous solution by HAP column procedure. More than 90 % of ⁹⁰Sr was adsorbed and removed from the ⁹⁰Sr containing solution. Divalent cations, Ca²⁺, had little effect on the removal of ⁹⁰Sr up to a concentration of 1 mmol L⁻¹. This clearly indicates that the HAP column technique is advantageous with respect to the capacity to adsorb ⁹⁰Sr from water present in the environment.