Renal dysfunction as an independent predictor of in-hospital complications in patients with st-elevation myocardial infarction

Abstract Background Renal impairment is a well-recognized marker of adverse cardiovascular prognosis. This study aimed to determine whether glomerular filtration rate (GFR) independently predicts in-hospital complications in patients with ST-elevation myocardial infarction (STEMI). Methods A total of 971 consecutive STEMI patients who underwent primary percutaneous coronary intervention (PCI) within 12 hours of symptom onset were included and categorized by baseline GFR: Group 1: <60 mL/min/1.73 m² (n = 129), Group 2: 60–90 (n = 538), Group 3: >90 (n = 303). Major in-hospital complications included atrial fibrillation (AF), high degree atrioventricular(AV) block, in-hospital pneumonia, and in-hospital death. Multivariable logistic regression was used to evaluate associations between GFR group and complications, adjusting for age, sex, arterial Hypertension (AH), and diabetes Mellitus (DM). Results Event counts across GFR groups were: AF: 15/129 (<60), 28/538 (60–90), 9/303 (>90) High degree AV block: 11/129, 14/538, 7/303 In-hospital pneumonia: 17/129, 35/538, 13/303 In-hospital death: 4/129, 7/538, 3/303 After adjustment, GFR <60 remained an independent predictor of several complications: AF: aOR 2.88 (95% CI 1.13–7.33, p=0.026) High degree AV block: aOR 3.71 (1.25–10.98, p=0.018) In-hospital pneumonia: aOR 2.31 (1.01–5.29, p=0.048) In-hospital mortality showed a non-significant trend (aOR 1.87, 0.34–10.28, p=0.47). Additional independent predictors included age (AF aOR 1.05 per year, p=0.0004; in-hospital pneumonia aOR 1.04, p=0.009) and DM (in-hospital pneumonia aOR 1.95, p=0.022; in-hospital death aOR 7.52, p=0.001). Conclusions In this cohort of 971 STEMI patients, renal dysfunction (GFR <60 mL/min/1.73 m²) was independently associated with AF, High degree AV block, and in-hospital pneumonia, but not mortality. DM and older age further amplified risk. These findings underscore the prognostic significance of renal impairment and the need for targeted in-hospital monitoring of this high-risk population.Baseline Characteristics by GFR GroupFor image description, please refer to the figure legend and surrounding text. Adjusted Outcomes According to GFR GroupFor image description, please refer to the figure legend and surrounding text.