What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction and renal dysfunction (n=3106). Intervention: End-stage renal disease vs. No renal disease. Primary outcome: Postdischarge death (HR 5.4, 95% CI 3.0-9.7, p=<0.001).

October 1, 2002

Acute Myocardial Infarction and Renal Dysfunction: A High-Risk Combination

Q: What are the key findings of this study?

End-stage renal disease in patients with acute MI was associated with significantly higher postdischarge mortality compared to those without renal disease (HR 5.4; 95% CI 3.0-9.7; P<0.001).

Key Result

End-stage renal disease in patients with acute MI was associated with significantly higher postdischarge mortality compared to those without renal disease (HR 5.4; 95% CI 3.0-9.7; P<0.001).

Study Design

Type

Cohort (n=3,106)

Multicenter

Structured PICO

Does renal dysfunction increase the risk of mortality in patients with acute myocardial infarction?

Population

3,106 patients admitted with acute myocardial infarction, stratified by varying levels of renal disease to assess short- and long-term survival.

Exposure

Varying levels of renal dysfunction (mild, moderate, severe, end-stage renal disease)

Comparator

No renal disease

Outcome

In-hospital mortality and postdischarge deathhard clinical

Renal dysfunction is a strong, graded predictor of increased in-hospital and postdischarge mortality in patients with acute myocardial infarction, who also receive less aggressive reperfusion and adjunctive therapies.

Main Result

Hazard Ratio: 5.4 (95% CI 3–9.7)

p-value: p=<0.001

Abstract

BACKGROUND: Survival is poor in patients with acute myocardial infarction (MI) who also have severe renal disease. Less is known about the outcome of acute MI in patients with mild to moderate renal insufficiency. OBJECTIVE: To compare outcomes after acute MI in patients with varying levels of renal disease and in patients without renal failure. DESIGN: Retrospective cohort study. SETTING: Academic medical center. PATIENTS: 3106 total patients admitted with acute MI and end-stage renal disease (n = 44), severe renal insufficiency (creatinine clearance or = 0.59 mL/s 0.84 mL/s [>50 mL/min but < or =1.25 mL/s < or =75 mL/min) (n = 860), or no renal disease (n = 1320). MEASUREMENTS: Clinical characteristics, treatment strategies, and short- and long-term survival were compared after patients were stratified by creatinine clearance. RESULTS: In-hospital mortality rates were 2% in patients with normal renal function, 6% in those with mild renal failure, 14% in those with moderate renal failure, 21% in those with severe renal failure, and 30% in those with end-stage renal disease (P < 0.001). Compared with patients without renal disease, similar adjusted trends were present for postdischarge death in patients with end-stage renal disease (hazard ratio, 5.4 95% CI, 3.0 to 9.7; P < 0.001), severe renal insufficiency (hazard ratio, 1.9 CI, 1.2 to 3.0; P = 0.006), moderate renal dysfunction (hazard ratio, 2.2 CI, 1.5 to 3.3; P < 0.001), and mild chronic renal insufficiency (hazard ratio, 2.4 CI, 1.7 to 3.3; P < 0.001). Patients with renal failure received adjunctive and reperfusion therapies less frequently than those with normal renal function (P < 0.001). Postdischarge death was less likely in patients who received acute reperfusion therapy (odds ratio, 0.7 CI, 0.6 to 0.9), aspirin (odds ratio, 0.7 CI, 0.5 to 0.8), and beta-blocker therapy (odds ratio, 0.7 CI, 0.6 to 0.9). CONCLUSION: Patients with renal failure are at increased risk for death after acute MI and receive less aggressive treatment than patients with normal renal function.

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