How renal function influences post-acute myocardial infarction (AMI) cardiac remodeling and outcomes remains unclear. This study evaluated the impact of levels of renal impairment on drug therapy, echocardiographic parameters, and outcomes in patients with AMI undergoing percutaneous coronary intervention (PCI). A total of 611 patients diagnosed with AMI underwent successful PCI, and two echocardiographic examinations were performed within 1 year after AMI. Patients were categorized according to Group 1: severely impaired estimated glomerular filtration rate (eGFR)<30, Group 2: mildly impaired 30≤eGFR<60, Group 3: potentially at risk 60≤eGFR<90 and normal eGFR≥90 ml/min/1.73 m2. During the 5-year follow-up period, the primary endpoints were cardiovascular mortality and outcomes. Patients with worse renal function (eGFR<30) were older and had a higher prevalence of hypertension and diabetes, but relatively few were smokers or had hyperlipidemia. Despite more patients with lesions of the left anterior descending artery, those with worse renal function received suboptimal guideline-directed medical therapy (GDMT). Notably, patients with worse renal function presented with worse left ventricular function at baseline and subsequent follow-up. Kaplan-Meier analysis revealed increased cardiovascular death, development of heart failure, recurrent AMI and revascularization in patients with worse renal function. Notably, as focusing on patients with ST elevation MI, the similar findings were observed. In multivariable Cox regression, impaired renal function showed the most significant hazard ratio in cardiovascular death. Collectively, in AMI patients receiving PCI, outcome differences are renal function dependent. We found that patients with worse renal function received less GDMT and presented with worse cardiovascular outcomes. These patients require more attention.

中文翻译：

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肾功能损害对心肌梗死后心脏重构和临床结局的影响

肾功能如何影响急性心肌梗死 (AMI) 后的心脏重塑和结果尚不清楚。本研究评估了肾功能损害水平对接受经皮冠状动脉介入治疗 (PCI) 的 AMI 患者的药物治疗、超声心动图参数和结果的影响。共有 611 名诊断为 AMI 的患者成功接受了 PCI，并在 AMI 后 1 年内进行了两次超声心动图检查。患者根据第 1 组进行分类：估计肾小球滤过率严重受损 (eGFR)<30，第 2 组：轻度受损 30≤eGFR<60，第 3 组：潜在风险 60≤eGFR<90 且正常 eGFR≥90 ml/min /1.73 平方米。在 5 年随访期间，主要终点是心血管死亡率和结局。肾功能较差的患者（eGFR< 30) 年龄较大，高血压和糖尿病的患病率较高，但吸烟者或高脂血症者相对较少。尽管左前降支病变患者较多，但肾功能较差的患者接受了次优的指南指导药物治疗（GDMT）。值得注意的是，肾功能较差的患者在基线和后续随访时左心室功能较差。Kaplan-Meier 分析显示，肾功能较差的患者心血管死亡、心力衰竭、AMI 复发和血运重建增加。值得注意的是，在关注 ST 段抬高 MI 患者时，也观察到了类似的发现。在多变量 Cox 回归中，肾功能受损在心血管死亡中显示出最显着的风险比。总的来说，在接受 PCI 的 AMI 患者中，结果差异取决于肾功能。我们发现肾功能较差的患者接受的 GDMT 较少，心血管结局较差。这些患者需要更多的关注。