title: Suboptimal medical care of patients with ST-elevation myocardial infarction and renal insufficiency: results from the Korea Acute Myocardial Infarction Registry.
abstract: BACKGROUND
  The clinical outcomes of ST-segment elevation myocardial infarction (STEMI) are poor in patients with renal insufficiency. This study investigated changes in the likelihood that patients received optimal medical care throughout the entire process of myocardial infarction management, on the basis of their glomerular filtration rate (GFR).
  
  
  METHODS
  This study analyzed 7,679 patients (age, 63 ± 13 years; men 73.6%) who had STEMI and were enrolled in the Korea Acute Myocardial Infarction Registry (KAMIR) from November 2005 to August 2008. The study subjects were divided into 5 groups corresponding to strata used to define chronic kidney disease stages.
  
  
  RESULTS
  Patients with lower GFR were less likely to present with typical chest pain. The average symptom-to-door time, door-to-balloon time, and symptom-to-balloon time were longer with lower GFR than higher GFR. Primary reperfusion therapy was performed less frequently and the results of reperfusion therapy were poorer in patients with renal insufficiency; these patients were less likely to receive adjunctive medical treatment, such as treatment with aspirin, clopidogrel, β-blocker, angiotensin-converting enzyme (ACE) inhibitor/angiotensin-receptor blocker (ARB), or statin, during hospitalization and at discharge. Patients who received less intense medical therapy had worse clinical outcomes than those who received more intense medical therapy.
  
  
  CONCLUSIONS
  Patients with STEMI and renal insufficiency had less chance of receiving optimal medical care throughout the entire process of MI management, which may contribute to worse outcomes in these patients.
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju 501-757, South Korea.
authors.forename: Joon Seok
authors.initials: JS
authors.lastname: Choi
authors.forename: Chang Seong
authors.initials: CS
authors.lastname: Kim
authors.forename: Eun Hui
authors.initials: EH
authors.lastname: Bae
authors.forename: Seong Kwon
authors.initials: SK
authors.lastname: Ma
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Young Jo
authors.initials: YJ
authors.lastname: Kim
authors.forename: Myeong Chan
authors.initials: MC
authors.lastname: Cho
authors.forename: Chong Jin
authors.initials: CJ
authors.lastname: Kim
authors.forename: Soo Wan
authors.initials: SW
authors.lastname: Kim
mesh_terms: D000368:Aged; D015897:Comorbidity; D003695:Delivery of Health Care / Q000145:classification / Q000706:statistics & numerical data*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D015995:Prevalence; D012042:Registries; D051437:Renal Insufficiency / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D016896:Treatment Outcome