title: Chronic kidney disease and long-term outcomes of myocardial infarction.
abstract: BACKGROUND
  Although chronic kidney disease (CKD) is a risk factor for cardiovascular disease, information about myocardial infarction (MI) with CKD is limited in the acute revascularization era.
  
  
  METHODS
  To clarify the relationship between CKD and long-term outcomes of MI, consecutive 4550 patients with acute MI treated at 17 participating hospitals were analyzed. The primary study outcome was death from any cause, and a secondary endpoint was the first appearance major adverse cardiovascular events.
  
  
  RESULTS
  Acute revascularization therapies were performed in 75.2% of the patients and the mean left ventricular ejection fraction (LVEF) was 53%. The median follow-up was 4.1 years (follow-up rate, 95.2%). Patients were divided into four categories (<45.0, 45.0 to 59.9, 60.0 to 74.9, and ≥ 75.0 mL/min per 1.73 m(2) of body-surface area) according to the glomerular filtration rate (GFR) estimated by the Modification of Diet in Renal Disease equation. A total of 1941 (42.7%) patients had an estimated GFR of <60.0 mL/min per 1.73 m(2). Mortality rates increased with declining estimated GFR. Unadjusted hazard ratios for total and cardiovascular death in the group with an estimated GFR of 45.0 to 59.9 mL/min per 1.73 m(2) using the group with an estimated GFR of ≥ 75.0 mL/min per 1.73 m(2) as the reference were 1.63 (95% CI, 1.28 to 2.07) and 2.09 (95% CI, 1.45 to 3.01), respectively.
  
  
  CONCLUSIONS
  Even early-stage CKD should be considered a powerful risk factor for long-term cardiovascular death after acute MI with preserved LVEF in the acute revascularization era.
authors.affiliation: Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Michitaka
authors.initials: M
authors.lastname: Nagashima
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Hagiwara
authors.forename: Ryo
authors.initials: R
authors.lastname: Koyanagi
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Yamaguchi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takagi
authors.forename: Erisa
authors.initials: E
authors.lastname: Kawada-Watanabe
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Shiga
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome