title: Type of myocardial infarction presentation in patients with chronic kidney disease.
abstract: OBJECTIVE
  Association of coronary and renal disease has been frequently found in epidemiological studies. Whether ECG-graphic presentation of myocardial infarction [S-T Elevated MI (STEMI) or Non S-T Elevated MI (NSTEMI)] is related to the degree of renal dysfunction is still unclear.
  
  
  RESULTS
  We examined 146 patients with acute myocardial infarction, consecutively entering the Coronary Care Unit of our ward. At entry, patients underwent clinical, ECG-graphic and echocardiographic examination, and blood samples were withdrawn for cardiac markers and general biochemistry. GFR was calculated using the CKD-EPI equation. STEMI was found in 71 cases and NSTEMI in 75 cases. Renal function was normal in 61 patients (stage 1), mildly impaired (<90 mL/min/1.73 m(2) and ≥ 60 mL/min/1.73 m(2)) in 60 (stage 2) and moderately to severely impaired (GFR <60 mL/min/1.73 m(2)) in 25 cases (stages 3-4). Patients were, thereafter, clustered into two groups (stages 1-2 and stages 3-4). Compared to stage 1-2 subjects, stages 3-4 patients were older, were more likely to be diabetic and had more frequently previous cardiovascular diseases. The probability of presentation of NSTEMI for stage 3-4 patients was 4-fold greater than for stage 1-2 patients (p = 0.02).
  
  
  CONCLUSIONS
  These data support the evidence that 1) NSTEMI is associated with more severe kidney dysfunction, likely due to more severe and/or longer lasting exposition to risk factors; 2) cardiac and renal impairment are strongly associated. ClinicalTrials.gov Identifier: NCT01636427.
authors.affiliation: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy. Electronic address: ferrara@unina.it.
authors.forename: L A
authors.initials: LA
authors.lastname: Ferrara
authors.affiliation: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Staiano
authors.affiliation: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Di Fronzo
authors.affiliation: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Ferrara
authors.affiliation: Hypertension Research Center, Federico II University, Naples, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Sforza
authors.affiliation: Hypertension Research Center, Federico II University, Naples, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Mancusi
authors.affiliation: Hypertension Research Center, Federico II University, Naples, Italy.
authors.forename: G
authors.initials: G
authors.lastname: de Simone
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D015992:Body Mass Index; D001835:Body Weight; D002784:Cholesterol / Q000097:blood; D003404:Creatinine / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000145:classification / Q000150:complications / Q000175:diagnosis*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood
chemical_list: D014280:Triglycerides; D002784:Cholesterol; D003404:Creatinine
keywords: Chronic kidney disease; Non S-T Elevated MI (NSTEMI); S-T Elevated MI (STEMI)