Renal insufficiency is related to painless myocardial infarction.
BACKGROUND
Acute myocardial infarction (MI) sometimes occurs without painful symptoms and in such cases, prognosis is worsened by delays in diagnosis and revascularization. Renal insufficiency induces many types of neuropathy, but the relation between renal insufficiency and painless MI remains unclear.


RESULTS
Patients with MI and elevated creatine kinase levels were retrospectively analyzed. Renal insufficiency (serum creatinine concentration > or =1.5 mg/dl) and other characteristics (age, sex, body mass index, hypertension, smoking, diabetes mellitus, dyslipidemia, history of stroke, previous MI, hemodialysis, and atrial fibrillation) were compared between patients who had MI with painful symptoms (painful MI, n=131) and patients who had MI without painful symptoms (painless MI, n=18). Other variables compared were the time from symptom onset to admission, peak creatine kinase concentration, Killip class, site of MI, emergency coronary angiography, postprocedural Thrombolysis In Myocardial Infarction grade III flow, and in-hospital death. Univariate analysis identified older age, renal insufficiency, and previous MI as predictors of painless MI. Patients with painless MI showed higher rates of Killip class > or =II and in-hospital death and a longer time from symptom onset to admission. However, multivariate analysis identified only renal insufficiency as an independent predictor of painless MI.


CONCLUSIONS
MI without painful symptoms frequently develops in patients who have renal insufficiency, so the possibility of painless MI should be evaluated in such patients to ensure early diagnosis and treatment.
Komukai
Kimiaki
K
Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan. komu@jikei.ac.jp
Ogawa
Takayuki
T
Yagi
Hidenori
H
Date
Taro
T
Suzuki
Kiyofumi
K
Sakamoto
Hiroshi
H
Miyazaki
Hidekazu
H
Takatsuka
Hisashi
H
Shibayama
Kenri
K
Ogawa
Kazuo
K
Kanzaki
Yasuko
Y
Kosuga
Tsuneharu
T
Kawai
Makoto
M
Hongo
Kenichi
K
Yoshida
Satoru
S
Taniguchi
Ikuo
I
Mochizuki
Seibu
S
D000368:Aged; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D003402:Creatine Kinase / Q000097:blood; D003404:Creatinine / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D009204:Myocardial Revascularization; D051437:Renal Insufficiency / Q000097:blood / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors
D003404:Creatinine; D003402:Creatine Kinase