title: Renal dysfunction on admission, worsening renal function, and severity of acute kidney injury predict 2-year mortality in patients with acute myocardial infarction.
abstract: BACKGROUND
  Recent studies have proven that initial renal dysfunction and worsening renal function during hospitalization can predict the clinical outcome of patients with acute myocardial infarction (AMI). There is limited study regarding acute kidney injury (AKI) by the RIFLE classification (Risk of renal failure, Injury to the kidney, Failure of kidney function, Loss of kidney function, and End-stage renal failure) to assess the outcome of AMI survivors.
  
  
  RESULTS
  During a mean follow-up period of 635.3 ± 204.9 days, the 2-year mortality rate was 10.6% in 613 AMI patients who survived to discharge. Adjusted Cox regression analysis revealed that left ventricular dysfunction (<40%) [hazard ratio (HR), 2.83; 95% confidence interval (CI), 1.11-7.20; P=0.029], estimated glomerular filtration rate <60 ml min(-1) x 1.73 m(-2) on admission (HR, 4.01; 95% CI, 1.51-10.62; P=0.005), and AKI severity by RIFLE classification during first week after hospitalization (Injury: HR, 8.11; 95% CI, 2.53-26.05; P=0.001; Failure: HR, 19.28; 95% CI, 2.24-166.26; P=0.007) were independent predictors of 2-year mortality.
  
  
  CONCLUSIONS
  Independent of initial renal dysfunction on admission, the AKI severity by RIFLE classification may be useful in establishing the hospital discharge risk score for predicting long-term mortality in AMI patients who survive to discharge.
authors.affiliation: Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.
authors.forename: Ming-Jer
authors.initials: MJ
authors.lastname: Hsieh
authors.forename: Yung-Chang
authors.initials: YC
authors.lastname: Chen
authors.forename: Chun-Chi
authors.initials: CC
authors.lastname: Chen
authors.forename: Chun-Li
authors.initials: CL
authors.lastname: Wang
authors.forename: Lung-Sheng
authors.initials: LS
authors.lastname: Wu
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Wang
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000503:physiopathology; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000401:mortality / Q000503:physiopathology