In patients presenting to the emergency department with chest pain, advanced renal dysfunction or dialysis was associated with a 40.2% rate of cumulative MI, heart failure, and death at 30 days.
Observational (n=817)
Does advanced chronic kidney disease affect processes of care and 30-day outcomes in patients presenting to the emergency department with chest discomfort?
Advanced chronic kidney disease is a strong marker for adverse in-hospital and 30-day outcomes, including a 40.2% rate of MI, heart failure, or death, in patients presenting to the emergency department with chest pain.
BACKGROUND: Increased rates of myocardial infarction, heart failure, arrhythmias, and death occur in patients with chronic kidney disease. We sought to evaluate the processes of care and outcomes in patients with chronic kidney disease presenting to an emergency department with chest discomfort. METHODS: We enrolled 817 consecutive patients who underwent evaluation for a possible acute myocardial infarction in a prospective study of cardiac biomarkers. Renal dysfunction did not exclude patients from this study, and baseline renal function and 30-day outcomes were available in 808. Patients were stratified by corrected creatinine clearance rate into quartiles, with those undergoing dialysis (n = 51) as a fifth comparison group. RESULTS: Those patients with advanced renal dysfunction (corrected creatinine clearance rate, <47.0 mL/min <0.8 mL/s per 72 kg) or who underwent dialysis had higher rates of diabetes, hypertension, and prior coronary disease. More than 99% of all patients were admitted to a chest pain observation unit or to the hospital. Rates of stress testing were lower as renal dysfunction worsened. Rates of revascularization, however, were similar for all groups. The most frequent in-hospital complication was the development of heart failure, which occurred in 36.5% of those with a corrected creatinine clearance rate of less than 47.0 mL/min per 72 kg. At 30 days, this group had the highest rates of cumulative myocardial infarction, development of heart failure, and death (40.2%). CONCLUSION: Chronic kidney disease is a marker for in-hospital and 30-day outcomes in patients presenting to the emergency department with chest discomfort.
McCullough et al. (2002) conducted an observational in Chest discomfort with possible acute myocardial infarction (n=817). Advanced renal dysfunction (creatinine clearance <47.0 mL/min) or dialysis vs. Better renal function (higher quartiles of creatinine clearance) was evaluated on Cumulative myocardial infarction, development of heart failure, and death at 30 days. In patients presenting to the emergency department with chest pain, advanced renal dysfunction or dialysis was associated with a 40.2% rate of cumulative MI, heart failure, and death at 30 days.