Key result
Severe renal dysfunction was associated with a significantly increased risk of in-hospital mortality (OR 7.0) compared to normal renal function in patients with acute myocardial infarction.
Why the study?
Does renal function assessed by GFR predict mortality and adverse events in acute MI patients with normal or mildly elevated serum creatinine?
Cohort (n=6,834)
Yes
Does renal function assessed by GFR predict mortality and adverse events in acute MI patients with normal or mildly elevated serum creatinine?
Odds Ratio: 7 (95% CI 3.2–18.2)
Absolute Event Rate: 16.9% vs 1.3%
p-value: p=0.001
Even in acute MI patients with normal or mildly elevated serum creatinine, reduced GFR is a significant predictor of mortality and adverse events, highlighting the importance of GFR assessment.
GFR assessment may aid risk stratification in acute MI beyond creatinine; leaves open whether GFR-guided strategies improve outcomes.
BACKGROUND: The aim of the present study was to evaluate the relationship between clinical outcomes after acute myocardial infarction (MI) and renal function by glomerular filtration rate (GFR) in patients with normal or mildly elevated serum creatinine concentrations. METHODS AND RESULTS: As part of the Korean Acute Myocardial Infarction Registry (KAMIR), 6,834 acute MI patients with a serum creatinine concentration of 90.0; (2) preserved function, 75.0-89.9; (3) mild dysfunction, 60.0-74.9; (4) moderate dysfunction, 45.0-59.9; (5) severe dysfunction, <45 ml.min(-1). 1.73 m(-2). Clinical characteristics, mortality and adverse events were analyzed among each group. Although reperfusion and medical therapies were underused, the rates of mortality and adverse events were increased with declining renal function. After adjustment with confounders, severe and moderate renal dysfunctions were important risk predictors of in-hospital mortality, long-term mortality and adverse events. CONCLUSION: The spectrum of renal function, when it was presented by GFR, is broad and is an important risk predictor for adverse outcomes after acute MI, even in patients with normal or mildly elevated serum creatinine concentrations. Furthermore, standard treatments were underused in any degree of renal dysfunction.
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Lee et al. (2008) conducted a cohort in Acute myocardial infarction (n=6,834). Severe renal dysfunction (eGFR <45 ml/min/1.73m2) vs. Normal renal function (eGFR >90 ml/min/1.73m2) was evaluated on In-hospital mortality (OR 7.0, 95% CI 3.2-18.2, p=0.001). Severe renal dysfunction was associated with a significantly increased risk of in-hospital mortality (OR 7.0) compared to normal renal function in patients with acute myocardial infarction.
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