title: GFR and cardiovascular outcomes after acute myocardial infarction: results from the Korea Acute Myocardial Infarction Registry.
abstract: BACKGROUND
  Despite strong evidence linking decreased glomerular filtration rate (GFR) to worse outcomes, the impact of GFR on mortality and morbidity in patients with acute myocardial infarction (AMI) is not well defined.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  12,636 patients with AMI in the Korea AMI Registry database from November 2005 to July 2008. 93% of patients in this registry had coronary angiography, and 91% of patients with coronary angiography had percutaneous coronary intervention (PCI).
  
  
  METHODS
  GFR was estimated (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, and patients were grouped into 5 eGFR categories: >90, 60-89, 30-59, 15-29, and <15 mL/min/1.73 m(2).
  
  
  RESULTS
  Primary end points were death and in-hospital complications. Secondary end points were major adverse cardiac events (MACEs) during a 1-month (short-term) and 1-year (long-term) follow-up after AMI.
  
  
  RESULTS
  Mean eGFR was 72.8 ± 24.6 mL/min/1.73 m(2), mean age was 64 ± 13 years, and 70.4% were men. A graded association was observed between eGFR and clinical outcomes. In adjusted analyses, compared with eGFR >90 mL/min/1.73 m(2), patients with eGFR of 30-59, 15-29, and <15 mL/min/1.73 m(2) experienced increased risks of short- (respective HRs of 2.30 [95% CI, 1.70-3.11], 3.10 [95% CI, 2.14-4.14], and 3.64 [95% CI, 2.44-5.43]; P < 0.001) and long-term MACEs (HRs of 1.58 [95% CI, 1.32-1.90], 2.12 [95% CI, 1.63-2.75], and 2.50 [95% CI, 1.89-3.29]; P < 0.001). Older age, Killip class higher than I, PCI, and high-sensitivity C-reactive protein level also were associated with higher short- and long-term MACEs. Use of β-blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), and statins was associated with decreased risk of MACEs.
  
  
  CONCLUSIONS
  Single assessment of serum creatinine.
  
  
  CONCLUSIONS
  eGFR was associated independently with mortality and complications after AMI. PCI, β-blocker, ACE inhibitor or ARB, and statin use were associated with decreased risks of short- and long-term MACEs.
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Eun Hui
authors.initials: EH
authors.lastname: Bae
authors.forename: Sang Yup
authors.initials: SY
authors.lastname: Lim
authors.forename: Kyung Hoon
authors.initials: KH
authors.lastname: Cho
authors.forename: Joon Seok
authors.initials: JS
authors.lastname: Choi
authors.forename: Chang Seong
authors.initials: CS
authors.lastname: Kim
authors.forename: Jeong Woo
authors.initials: JW
authors.lastname: Park
authors.forename: Seong Kwon
authors.initials: SK
authors.lastname: Ma
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Soo Wan
authors.initials: SW
authors.lastname: Kim
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007677:Kidney Function Tests; D007723:Korea; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D011237:Predictive Value of Tests; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome