title: Clinical significance of chronic kidney disease and atrial fibrillation on morbidity and mortality in patients with acute myocardial infarction.
abstract: OBJECTIVE
  Atrial fibrillation (AF) often coexists with acute myocardial infarction (AMI), and chronic kidney disease (CKD) is a major risk for AMI. However, the combined impact of CKD and AF on the mortality and morbidity in AMI population has not been determined.
  
  
  METHODS
  Between January 2004 and December 2009, a total of 4,738 AMI patients were enrolled prospectively. Patients were divided into four groups according to the combined status of CKD and AF. The primary endpoint was a combination of 5-year major adverse cardiac and cerebrovascular events (MACCE).
  
  
  RESULTS
  The prevalence of AF was significantly higher in CKD patients than in non-CKD patients (6.76 vs. 3.31%, p < 0.001). The highest cumulative event rate of MACCE and death was observed in patients with both CKD and AF (68.5 and 64.0%), respectively. In multivariable analyses, compared with patients with neither AF nor CKD, hazard ratios (HR) for composite of MACCE were 1.66 (95% CI, 1.14-2.41), 1.24 (95% CI, 1.06-1.46), and 2.10 (95% CI, 1.42-3.13) for patients with AF only, those with CKD only, and those with both CKD and AF, respectively (p for interaction = 0.935). Patients with both CKD and AF had a greatest risk for all-cause mortality (HR 2.54; 95% CI, 1.60-4.53), and the significant synergistic interaction was observed between CKD and AF (p for interaction = 0.015).
  
  
  CONCLUSIONS
  The combined effect of AF and CKD on the risk of MACCE after an AMI is stronger than any separate condition, and it confers a synergistic effect on the all-cause mortality risk.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Hyeon Seok
authors.initials: HS
authors.lastname: Hwang
authors.forename: Mahn-Won
authors.initials: MW
authors.lastname: Park
authors.forename: Hye Eun
authors.initials: HE
authors.lastname: Yoon
authors.forename: Yoon Kyung
authors.initials: YK
authors.lastname: Chang
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Yang
authors.forename: Suk Young
authors.initials: SY
authors.lastname: Kim
authors.forename: Jung Sun
authors.initials: JS
authors.lastname: Cho
authors.forename: Chan Joon
authors.initials: CJ
authors.lastname: Kim
authors.forename: Gyung-Min
authors.initials: GM
authors.lastname: Park
authors.forename: Chul-Soo
authors.initials: CS
authors.lastname: Park
authors.forename: Yun-Seok
authors.initials: YS
authors.lastname: Choi
authors.forename: Yoon-Seok
authors.initials: YS
authors.lastname: Koh
authors.forename: Jong Min
authors.initials: JM
authors.lastname: Lee
authors.forename: Dong Il
authors.initials: DI
authors.lastname: Shin
authors.forename: Suk Min
authors.initials: SM
authors.lastname: Seo
authors.forename: Doo Soo
authors.initials: DS
authors.lastname: Jeon
authors.forename: Keon Woong
authors.initials: KW
authors.lastname: Moon
authors.forename: Ki Dong
authors.initials: KD
authors.lastname: Yoo
authors.forename: Hee Yeol
authors.initials: HY
authors.lastname: Kim
authors.forename: Dong-Bin
authors.initials: DB
authors.lastname: Kim
authors.forename: Hun-Jun
authors.initials: HJ
authors.lastname: Park
authors.forename: Pum-Joon
authors.initials: PJ
authors.lastname: Kim
authors.forename: Kiyuk
authors.initials: K
authors.lastname: Chang
authors.forename: Wook-Sung
authors.initials: WS
authors.lastname: Chung
authors.forename: Ki-Bae
authors.initials: KB
authors.lastname: Seung
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Sung-Ho
authors.initials: SH
authors.lastname: Her
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications*; D002561:Cerebrovascular Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality; D011446:Prospective Studies; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D056910:Republic of Korea / Q000453:epidemiology