Original Article| Volume 29, P88-92, April 2016

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Temporal trends in the outcomes of patients with acute myocardial infarction associated with renal dysfunction over the past decade

Published:January 13, 2016DOI:


      • Admission GFR is an independent predictors of mortality of patients with AMI.
      • The 1-year mortality risk increased by 2% for each 1 ml decrease in eGFR.
      • Prognosis of AMI patients with renal failure has improved over the last decade.
      • This improvement may be the result of improvement in medical management.



      Patients with renal dysfunction (RD) who present with acute myocardial infarction (AMI) are at a high risk for subsequent cardiovascular morbidity and mortality. We sought to evaluate changes in the short and long term mortality of AMI patients with RD compared to patients with normal renal function over the last decade.


      This study based on 4 bi-annually surveys was performed from 2002 to 2010 and included 9468 AMI patients, that were followed for 1 year, of whom 2770 (29%) had reduced estimated GFR ([eGFR] < 60 ml/min/m2). Among patients with reduced eGFR: 1251 patients (45%) were included in the 2002–2005 surveys (early period) and 1519 (55%) in the 2006–2010 surveys (late period).


      Patients with RD were more likely to have advanced cardiovascular disease, multiple comorbidities and higher in-hospital, 30-day, and 1-year mortality rates (8.1%,12.3% and 23% vs. 0.7%, 1.7% and 4%, respectively; all p < 0.001). Patients with RD enrolled during the late survey periods were more likely to undergo primary PCI and be discharged with current evidence based medical treatment. 1-year mortality rates were significantly lower among patients with RD who were enrolled during the late vs. early survey periods: 22% vs. 25% respectively; (Log-rank P-value <0.001). Consistently, multivariate analysis showed that patients with RD who were enrolled during the late survey periods displayed a lower adjusted risk for 1-year mortality (HR 0.83; CI[0.70–0.94] P = 0.01).


      Prognosis of patients with RD admitted with AMI has significantly improved over the last decade, possibly due to an improvement of pharmacological and non-pharmacological management.


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        • Foley R.N.
        • Parfrey P.S.
        • Sarnak M.J.
        Epidemiology of cardiovascular disease in chronic renal disease.
        J Am Soc Nephrol. 1998; 9: S16-S23
        • Luft F.C.
        Renal disease as a risk factor for cardiovascular disease.
        Basic Res Cardiol. 2000; 95: I72-I76
        • Sarnak M.J.
        • Levey A.S.
        Cardiovascular disease and chronic renal disease: a new paradigm.
        Am J Kidney Dis. 2000; 35: S117-S131
        • Sorensen C.R.
        • Brendorp B.
        • Rask-Madsen C.
        • Kober L.
        • Kjoller E.
        • Torp-Pedersen C.
        The prognostic importance of creatinine clearance after acute myocardial infarction.
        Eur Heart J. 2002; 23: 948-952
        • McCullough P.A.
        Beyond serum creatinine: defining the patient with renal insufficiency and why?.
        Rev Cardiovasc Med. 2003; 4: S2-S6
        • Al-Ahmad A.
        • Rand W.M.
        • Manjunath G.
        • Konstam M.A.
        • Salem D.N.
        • Levey A.S.
        • et al.
        Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction.
        J Am Coll Cardiol. 2001; 38: 955-962
        • Manjunath G.
        • Tighiouart H.
        • Ibrahim H.
        • MacLeod B.
        • Salem D.N.
        • Griffith J.L.
        • et al.
        Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community.
        J Am Coll Cardiol. 2003; 41: 47-55
        • Schiele F.
        • Legalery P.
        • Didier K.
        • Meneveau N.
        • Seronde M.F.
        • Caulfield F.
        • et al.
        Impact of renal dysfunction on 1-year mortality after acute myocardial infarction.
        Am Heart J. 2006; 151: 661-667
        • Santopinto J.J.
        • Fox K.A.
        • Goldberg R.J.
        • Budaj A.
        • Piñero G.
        • Avezum A.
        • et al.
        Creatinine clearance and adverse hospital outcomes in patients with acute coronary syndromes: findings from the global registry of acute coronary events (GRACE).
        Heart. 2003; 89: 1003-1008
        • Anavekar N.S.
        • McMurray J.J.
        • Velazquez E.J.
        • Solomon S.D.
        • Kober L.
        • Rouleau J.L.
        • et al.
        Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction.
        N Engl J Med. 2004; 351: 1285-1295
        • Campbell N.G.
        • Varagunam M.
        • Sawhney V.
        • Ahuja K.R.
        • Salahuddin N.
        • De Palma R.
        • et al.
        Mild chronic kidney disease is an independent predictor of long-term mortality after emergency angiography and primary percutaneous intervention in patients with ST-elevation myocardial infarction.
        Heart. 2012; 98: 42-47
        • Fisher K.A.
        • Darling C.
        • McManus D.
        • Maitas O.
        • Yarzebski J.
        • Gore J.M.
        • et al.
        Recent trends in post-discharge mortality among patients with an initial acute myocardial infarction.
        Am J Cardiol. 2012; 110: 1073-1077
        • Behar S.
        • Battler A.
        • Porath A.
        • Leor J.
        • Grossman E.
        • Hasin Y.
        Israel heart and internal medicine societies: a prospective national survey of management and clinical outcome of acute myocardial infarction in Israel, 2000.
        Isr Med Assoc J. 2003; 5: 249-254
        • Levey A.S.
        • Greene T.
        • Kusek J.W.
        • et al.
        A simplified equation to predict glomerular filtration rate from serum creatinine.
        J Am Soc Nephrol. 2000; 11: 155A
        • Foundation N.K.
        K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification.
        Am J Kidney Dis. 2002; 39: S1-266
        • Ferrer-Hita J.J.
        • Dominguez-Rodriguez A.
        • Garcia-Gonzalez M.J.
        • Abreu-Gonzalez P.
        Renal dysfunction is an independent predictor of in-hospital mortality in patients with ST-segment elevation myocardial infarction treated with primary angioplasty.
        Int J Cardiol. 2007; 118: 243-245
        • Kümler T.
        • Gislason G.H.
        • Kober L.
        • Gustafsson F.
        • Schou M.
        • Torp-Pedersen C.
        Renal function at the time of a myocardial infarction maintains prognostic value for more than 10 years.
        BMC Cardiovasc Disord. 2011; 11: 37
        • Goldberg A.
        • Hammerman H.
        • Petcherski S.
        • Zdorovyak A.
        • Yalonetsky S.
        • Kapeliovich M.
        • et al.
        Inhospital and 1-year mortality of patients who develop worsening renal function following acute ST-elevation myocardial infarction.
        Am Heart J. 2005; 150: 330-337
        • Amin A.P.
        • Spertus J.A.
        • Reid K.J.
        • Lan X.
        • Buchanan D.M.
        • Decker C.
        • et al.
        The prognostic importance of worsening renal function during an acute myocardial infarction on long-term mortality.
        Am Heart J. 2010; 160: 1065-1071
        • Nauta S.T.
        • van Domburg R.T.
        • Nuis R.J.
        • Akkerhuis M.
        • Deckers J.W.
        Decline in 20-year mortality after myocardial infarction in patients with chronic kidney disease: evolution from the prethrombolysis to the percutaneous coronary intervention era.
        Kidney Int. 2013; 84: 353-358
        • Fabbian F.
        • Pala M.
        • De Giorgi A.
        • Manfredini F.
        • Mallozzi Menegatti A.
        • Salmi R.
        • et al.
        In-hospital mortality in patients with renal dysfunction admitted for myocardial infarction: the Emilia-Romagna region of Italy database of hospital admissions.
        Int Urol Nephrol. 2013; 45 (Jun): 769-775
        • Alexander K.P.
        • Newby L.K.
        • Armstrong P.W.
        • Cannon C.P.
        • Gibler W.B.
        • Rich M.W.
        • et al.
        Acute coronary care in the elderly, part II: ST-segment-elevation myocardial infarction: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology.
        Circulation. 2007; 115: 2570-2589