title: In-hospital mortality in patients with renal dysfunction admitted for myocardial infarction: the Emilia-Romagna region of Italy database of hospital admissions.
abstract: BACKGROUND
  In-hospital mortality of patients with myocardial infarction (MI) in different European populations and renal dysfunction is variable. We aimed to evaluate in-hospital mortality for MI in chronic kidney disease (CKD), in end-stage renal disease (ESRD), and in subjects admitted for MI without renal dysfunction living in the Emilia-Romagna region of Italy.
  
  
  METHODS
  We considered all cases of MI (first event) recorded in the database of hospital admissions of the region Emilia-Romagna of Italy, from January 1999 to December 2009. The criterion for inclusion was the presence, as a first discharge diagnosis, of acute MI (International Classification of Diseases, 9th Revision, Clinical Modification). The Charlson comorbidity index (CCI), with the exclusion of CKD, was calculated. The outcome variable was in-hospital mortality for MI, and its association with comorbidities, CKD and ESRD, was analyzed.
  
  
  RESULTS
  During the considered period, 88,014 cases of first MI were recorded. The percentage of patients admitted with MI and died during hospitalization were higher in patients with ESRD (38.3 %) and CKD (16.5 %) than in those without renal dysfunction (14 %) (p < 0.01). In CKD and ESRD patients, data of in-hospital mortality for MI exhibited a twofold increase in the analyzed period. In-hospital mortality for MI was independently associated with age (OR 1.077, 95 % CI 1.075-1.080, p < 0.001), CCI excluding CKD (OR 1.101, 95 % CI 1.069-1.134, p < 0.001), cerebrovascular disease (OR 1.450, 95 % CI 1.349-1.557, p < 0.001), malignancy (OR 1.234, 95 % CI 1.153-1.320, p < 0.001), and ESRD (OR 4.137, 95 % CI 3.511-4.875, p < 0.001).
  
  
  CONCLUSIONS
  As for the Emilia-Romagna region of Italy, in-hospital mortality for MI is increasing over the last years, and mortality seems to be related with patients' comorbidities and presence of advanced stages of CKD.
authors: Department of Internal Medicine, Clinica Medica, Azienda Ospedaliera-Universitaria, Via Aldo Moro, 44124, Ferrara, Italy. f.fabbian@ospfe.it
authors: Fabio
authors: F
authors: Fabbian
authors: Marco
authors: M
authors: Pala
authors: Alfredo
authors: A
authors: De Giorgi
authors: Fabio
authors: F
authors: Manfredini
authors: Alessandra
authors: A
authors: Mallozzi Menegatti
authors: Raffaella
authors: R
authors: Salmi
authors: Francesco
authors: F
authors: Portaluppi
authors: Massimo
authors: M
authors: Gallerani
authors: Roberto
authors: R
authors: Manfredini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D007558:Italy / Q000453:epidemiology; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000628:therapy; D051437:Renal Insufficiency / Q000150:complications / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors