Clinical Investigation
Acute Ischemic Heart Disease
Impact of renal dysfunction on 1-year mortality after acute myocardial infarction

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Background

Survival after acute myocardial infarction (MI) is linked to multiple factors, including mild or severe chronic kidney dysfunction. The aim of this study was to determine to what extent a reduction in glomerular filtration rate (GFR) influences 1-year mortality when risk level at admission and quality of care are taken into account.

Methods

A prospective registry was carried out in a geographically delimited area, including all patients admitted with a diagnosis of acute MI over a 6-month period. The GFR was calculated from serum creatinine levels, and patients were stratified into 3 groups: GFR1 >59 mL/min per 1.73 m2, GFR2 >29 and <60 mL/min per 1.73 m2, and GFR3 <30 mL/min per 1.73 m2. A risk index based on initial presentation was calculated. Inhospital and discharge treatments were recorded, taking into account possible contraindications. Patients were followed up for 1 year to assess all-cause mortality rate.

Results

A total of 754 patients were included, 333 ST-elevation MI and 421 non–ST-elevation MI. Overall 1-year mortality was 11.5%. Patients with impaired GFR were older, with more comorbidities, and received fewer effective therapies (less reperfusion, glycoprotein IIb/IIIa receptor inhibitors, early angiography, β-blockers, and statins). One-year mortality increased as GFR decreased: GFR1 2.3% (5/215), GFR2 9.4% (31/328), and GFR3 24.2% (51/211) (P < .001 for trend). By multivariable logistic regression, a significant association was found between 1-year mortality and risk index (odds ratio [OR] 1.41, 95% CI 1.16-1.71 per 10% increase in risk index), GFR (OR 0.97, 95% CI 0.95-0.98 per additional GFR unit), use of β-blockers (OR 0.15, 95% CI 0.05-0.50 for users), and early coronary angiography (OR 0.26, 95% CI 0.32-0.66 for patients submitted to angiography).

Conclusions

In patients with acute MI, decreased GFR is associated with higher mortality, and this relation remains strong after adjustment for the level of risk at admission and the effective treatments used.

Section snippets

Study design and population

We recorded in a prospective cohort all admissions of patients with MI over a 6-month period (from October 2000 to March 2001) in a specific geographic area: every patient with a confirmed diagnosis of acute MI, with or without ST-segment elevation according to the new definition of MI,16 in 1 of the 12 cardiology centers in the region of Franche-Comté (a region in Eastern France with a population of 1.2 million), was included. At the time of study design, no data were available in our region

Results

During the 6-month recruitment period, 754 patients were admitted with a final diagnosis of MI, 333 (44%) with STEMI and 421 (56%) with NSTEMI (no patient refused to be included). The median serum creatinine level was 12.6 mg/L (range 10.5-15.7 mg/L), and the median GFR was 48 mL/min/ per 1.73m2(range 35-65 mL/min/ per 1.73m2). The distribution of GFR in the whole population is displayed in Figure 1.

Discussion

In this study, a clear relationship was observed between 1-year mortality and GFR in patients admitted for acute MI. This relation remained significant when adjusted for the risk index at admission and the use of effective treatment.

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