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

초록

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. © 2025 Hellenic Society of Cardiology

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