Highlights
- •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.
Abstract
Background
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.
Methods
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).
Results
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).
Conclusions
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.
Keywords
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Article info
Publication history
Published online: January 13, 2016
Accepted:
December 23,
2015
Received in revised form:
December 22,
2015
Received:
October 2,
2015
Identification
Copyright
© 2016 European Federation of Internal Medicine. Published by Elsevier Inc. All rights reserved.
