Original research

Comparative analysis of the impact of glomerular filtration rate on the course of ST-segment elevation myocardial infarction in women and men

N.V. Netyazhenko

O.O. Bogomolets National Medical University, Kyiv, Ukraine

The aim – to study and compare the impact of glomerular filtration rate on the course and the development of complications of ST-segment elevation myocardial infarction (MI) in women and men.

Materials and methods. The retrospective analysis of 520 cases of ST-segment elevation myocardial infarction included 211 (40.6 %) women (average age 68.3 ± 2.1 years) and 309 (59.4 %) men (average age 62.7 ± 3.2 years). The level of glomerular filtration rate (GFR) was determined using the formula CKD-EPI. The impact of chronic kidney disease on the MI course was analyzed. During the hospital period (average 28.0 ± 3.6 days) the combined endpoint (CEP), including death from all causes and from cardiovascular causes, the development of major adverse cardiovascular events (recurrence of nonfatal MI, stroke and acute left ventricular failure ≥ II class Killip) was evaluated.

Results. The thresholds of GFR associated with increased frequency of CEP were determined: in men –  32 mL/(min · 1.73 m2) (OR 3.3; 95 % CI 2.1–7.8; p < 0.001), in women –  51 mL/(min · 1.73 m2) (OR 4.6; 95 % CI 1.9–9.6; p < 0.001). Independent predictors of the decrease of GFR in patients with ST-segment elevation MI were established: age older than 60 years, presence of hypertension, type 2 diabetes and absence of reperfusion therapy. PCI and delayed early thrombolytic therapy > 4 hours from the appearance of the main symptoms (all p < 0.05) had adverse effect in women as well.

Conclusions. Unfavourable influence of chronic kidney disease upon MI course depends on GFR and is more significant in women than in men, already when GFR is 59 ml/(min · 1,73 m2). Survival of women and men with MI during hospital period is decreased at GFR  51 ml/(min · 1,73 m2) and  32 ml/(min · 1,73 m2), accordingly.

Key words: women, glomerular filtration rate, myocardial infarction.