Management and outcomes of renal disease and acute myocardial infarction.
BACKGROUND
Contemporary trends in the management and outcomes of chronic kidney disease patients who develop an acute myocardial infarction have not been adequately described, particularly from the more generalizable perspective of a population-based investigation.


METHODS
The study population consisted of 6219 residents of the Worcester, Massachusetts, metropolitan area who were hospitalized with acute myocardial infarction in 6 annual periods between 1995 and 2005. Patients were categorized as having preserved kidney function (n=3154), mild to moderate chronic kidney disease (n=2313), or severe chronic kidney disease (n=752) at the time of hospital admission.


RESULTS
Patients with chronic kidney disease were more likely to be older, to have a greater prevalence of comorbidities, and to experience significant in-hospital complications or die during hospitalization in comparison with patients with preserved kidney function. Although patients with chronic kidney disease were less likely to receive effective cardiac medications or undergo coronary interventional procedures than patients without kidney disease, we observed a marked increase in the use of effective cardiac medications and coronary interventional procedures in patients with chronic kidney disease during the period under study. In-hospital death rates declined over time among patients with chronic kidney disease, whereas these death rates remained unchanged among persons with normal kidney function.


CONCLUSIONS
The results of this study in residents of a large New England metropolitan area provide insights into changing trends in the treatment and impact of chronic kidney disease in patients hospitalized with acute myocardial infarction.
Santolucito
Paul A
PA
Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
Tighe
Dennis A
DA
McManus
David D
DD
Yarzebski
Jorge
J
Lessard
Darleen
D
Gore
Joel M
JM
Goldberg
Robert J
RJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002908:Chronic Disease; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003404:Creatinine / Q000097:blood; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D005919:Glomerular Filtration Rate; D006339:Heart Rate; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000503:physiopathology* / Q000628:therapy; D007902:Length of Stay; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D015995:Prevalence; D012107:Research Design; D012189:Retrospective Studies
D015415:Biomarkers; D002317:Cardiovascular Agents; D003404:Creatinine
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