Benefits of aspirin and beta-blockade after myocardial infarction in patients with chronic kidney disease.
BACKGROUND
There have been no randomized trials of cardioprotective therapy after acute myocardial infarction in patients with chronic kidney disease who should be largely eligible for aspirin (acetylsalicylic acid; ASA) and beta-blockers (BB) as a base of therapy.


METHODS
We analyzed a prospective coronary care unit registry of 1724 patients with ST-segment elevation myocardial infarction.


RESULTS
Usage rates were 52.3%, 19.0%, 15.2%, and 13.5% for ASA and BB (ASA+BB), BB alone, ASA alone, and no ASA or BB therapy. Patients who received ASA+BB were more likely to be male, free of earlier cardiac disease, and recipients of thrombolysis. Conversely, the absence of ASA+BB was observed in patients with heart failure on admission, left bundle branch block, atrial and ventricular arrhythmias, and shock. The combination of ASA+BB was used in 63.9%, 55.8%, 48.2%, and 35.5% of patients with corrected creatinine clearance values of >81.5, 81.5 to 63.1, 63.1 to 46.2, and <46.2 mL/min/72 kg (P <.0001). ASA+BB was used in 40.4% of patients undergoing dialysis. The age-adjusted relative risk reduction for the inhospital mortality rate was similar among all renal groups and ranged from 64.3% to 80.0% (all P <.0001).


CONCLUSIONS
ASA+BB is an underused therapy in patients with acute myocardial infarction who have underlying kidney disease.
Department of Basic Science, Cardiology Section, University of Missouri-Kansas City, School of Medicine, Truman Medical Center, Kansas City, Mo 64108, USA. mcculloughp@umkc.edu
Peter A
PA
McCullough
Keisha R
KR
Sandberg
Steven
S
Borzak
Michael P
MP
Hudson
Mukesh
M
Garg
Harold J
HJ
Manley
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000008:administration & dosage*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D016009:Chi-Square Distribution; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D001241:Aspirin