Clinical impact of admission estimated glomerular filtration rate categories in patients with acute myocardial infarction

Chronic kidney disease (CKD) is a well-established risk factor in acute myocardial infarction (AMI); however, the clinical relevance of admission estimated glomerular filtration rate (eGFR)-based categories remains unclear. We analyzed 10,870 patients from a prospective multicenter AMI registry in Japan. Patients were stratified into stages 1 (≥ 90), 2 (60–89), 3a (45–59), 3b (30–44), 4 (15–29), and 5 (< 15 mL/min/1.73 m 2 ) based on the admission eGFR. The primary endpoint was 30-day major adverse cardiovascular events (MACE), defined as cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke. Bleeding was defined as BARC type 3 or 5. More advanced admission eGFR stages were associated with a higher risk of adverse events. After multivariable adjustment, stages 4 and 5 were associated with a significantly higher risk of MACE compared with the reference group of stages 1 and 2 (stage 4: HR 2.12, 95% CI 1.03–4.33; stage 5: HR 4.14, 95% CI 1.54–11.09), whereas stages 3a and 3b were not significantly associated with MACE. In patients with AMI, clinical outcomes varied across admission eGFR categories, with more advanced renal dysfunction, particularly stages 4 and 5, associated with a higher risk of short-term MACE. Detailed categorization of admission eGFR may provide additional prognostic information for early risk assessment.