November 15, 2007
Renal Impairment Predicts Long-Term Mortality Risk after Acute Myocardial Infarction
Key Result
Compared with normal renal function, mild renal impairment increased 10-year mortality risk by 10%, and severe impairment more than doubled the risk at 1 year in patients with AMI.
Study Design
Type
Cohort (n=118,753)
Multicenter
Yes
Structured PICO
Does renal impairment predict long-term mortality in older patients after acute myocardial infarction?
P
Population
118,753 patients (age ≥65 yr) hospitalized with acute myocardial infarction (AMI) from the Cooperative Cardiovascular Project
I
Intervention
Renal impairment (mild to severe)
C
Comparator
Normal renal function
O
Outcome
Mortality at up to 10 yearshard clinical
Renal impairment is a strong, consistent predictor of long-term mortality up to 10 years after acute myocardial infarction, eventually surpassing traditional risk factors like blood pressure and systolic function.
Abstract
Renal function predicts mortality after acute myocardial infarction (AMI), but it is unknown whether the prognostic importance of renal function persists over time. This study examined how the association between renal function and mortality changed in the 10 yr after AMI in a cohort of patients. In 118,753 patients (age >/=65 yr) from the Cooperative Cardiovascular Project, mean Cockcroft-Gault creatinine clearance was 55 +/- 24 ml/min and estimated GFR was 57 +/- 21 ml/min per 1.73 m(2) at baseline. By 10 yr, 68% of patients had died. Compared with normal renal function, even mild renal impairment increased the 10-yr risk for mortality risk by 10%. Severe renal impairment more than doubled the risk for mortality at 1 yr, and this increased risk persisted at both 5 and 10 yr. At 1 yr, the contribution of creatinine clearance to mortality risk rivaled traditional factors such as BP and systolic function; by 10 yr, creatinine clearance surpassed these other risk factors, rivaled only by patient age. Associations with estimated GFR demonstrated similar trends. In conclusion, renal function in hospitalized patients with AMI is an important and consistent predictor of mortality for up to 10 yr.