Acute myocardial infarction and renal dysfunction: a high-risk combination.
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.


METHODS
Retrospective cohort study.


METHODS
Academic medical center.


METHODS
3106 total patients admitted with acute MI and end-stage renal disease (n = 44), severe renal insufficiency (creatinine clearance < 0.59 mL/s [<35 mL/min]) (n = 391), moderate renal dysfunction (creatinine clearance > or = 0.59 mL/s [<35 mL/min] but < or =0.84 mL/s [< or =50 mL/min]) (n = 491), mild chronic renal insufficiency (creatinine clearance > 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).


METHODS
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]).


CONCLUSIONS
Patients with renal failure are at increased risk for death after acute MI and receive less aggressive treatment than patients with normal renal function.
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications*; D015425:Myocardial Reperfusion; D011379:Prognosis; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D006493:Heparin; D003404:Creatinine; D001241:Aspirin