Relation between renal function, presentation, use of therapies and in-hospital complications in acute coronary syndrome: data from the SWEDEHEART register.
OBJECTIVE
To examine clinical characteristics, presenting symptoms, use of therapy and in-hospital complications in relation to renal function in patients with myocardial infarction (MI).


METHODS
Observational study.


METHODS
Nationwide coronary care unit registry between 2003-2006 in Sweden.


METHODS
Consecutive MI patients with available creatinine (n = 57,477).


RESULTS
Glomerular filtration rate was estimated with the Modification of Diet in Renal Disease Study formula. With declining renal function patients were older, had more co-morbidities and more often used cardio-protective medication on admission. Compared to patients with normal renal function, fewer with renal failure presented with chest pain (90% vs. 67%, P < 0.001), Killip I (89% vs. 58%, P < 0.001) and ST-elevation myocardial infarction (STEMI) (41% vs. 22%, P < 0.001). In a logistic regression model lower renal function was independently associated with a less frequent use of anticoagulant and revascularization in non-ST-elevation MI. The likelihood of receiving reperfusion therapy for STEMI was similar in patients with normal-to-moderate renal dysfunction, but decreased in severe renal dysfunction or renal failure. Reperfusion therapy shifted from primary percutaneous coronary intervention in 71% of patients with normal renal function to fibrinolysis in 58% of those with renal failure. Renal function was associated with a higher rate of complications and an exponential increase in in-hospital mortality from 2.5% to 24.2% across the renal function groups.


CONCLUSIONS
Renal insufficiency influences the presentation and reduces the likelihood of receiving treatment according to current guidelines. Short-term prognosis remains poor.
Szummer
K
K
Department of Medicine, Section of Cardiology, Huddinge, Karolinska Institute, Karolinska University Hospital, Stockholm. karolina.szummer@karolinska.se
Lundman
P
P
Jacobson
S H
SH
Schön
S
S
Lindbäck
J
J
Stenestrand
U
U
Wallentin
L
L
Jernberg
T
T
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D002316:Cardiotonic Agents / Q000008:administration & dosage; D004562:Electrocardiography; D004812:Epidemiologic Methods; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007677:Kidney Function Tests / Q000379:methods; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D009204:Myocardial Revascularization / Q000379:methods; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D013548:Sweden / Q000453:epidemiology
D000925:Anticoagulants; D002316:Cardiotonic Agents