title: Prevalence and prognostic impact of chronic kidney disease in STEMI from a gender perspective: data from the SWEDEHEART register, a large Swedish prospective cohort.
abstract: OBJECTIVE
  Gender differences in prevalence and prognostic impact of chronic kidney disease (CKD) in ST segment elevation myocardial infarction (STEMI) have been poorly evaluated. In STEMI, female gender has been independently associated with an increased risk of mortality. CKD has been found to be an important prognostic marker in myocardial infarction. The aim of this study was to evaluate gender differences in prevalence and prognostic impact of CKD on short-term and long-term mortality.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  The national quality register SWEDEHEART was used. In the beginning of the study period, 94% of the Swedish coronary care units contributed data to the register, which subsequently increased to 100%. The glomerular filtration rate was estimated (eGFR) according to Modification of Diet in Renal Disease Study (MDRD) and Cockcroft-Gault (CG).
  
  
  METHODS
  All patients with STEMI registered in SWEDEHEART from the years 2003-2009 were included (37,991 patients, 66% men).
  
  
  RESULTS
  Women had 1.6 (MDRD) to 2.2 (CG) times higher multivariable adjusted risk of CKD. Half of the women had CKD according to CG. CKD was associated with 2-2.5 times higher risk of in-hospital mortality and approximately 1.5 times higher risk of long-term mortality in both genders. Each 10 mL/min decline of eGFR was associated with an increased risk of in-hospital and long-term mortality (22-33% and 9-16%, respectively) and this did not vary significantly by gender. Both in-hospital and long-term mortality were doubled in women. After multivariable adjustment including eGFR, there was no longer any gender difference in early outcome and the long-term outcome was better in women.
  
  
  CONCLUSIONS
  Among patients with STEMI, female gender was independently associated with CKD. Reduced eGFR was a strong independent risk factor for short-term and long-term mortality without a significant gender difference in prognostic impact and seems to be an important reason why women have higher mortality than men with STEMI.
authors.affiliation: Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Sofia
authors.initials: S
authors.lastname: Sederholm Lawesson
authors.affiliation: Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Joakim
authors.initials: J
authors.lastname: Alfredsson
authors.affiliation: Department of Cardiology, Karolinska University Hospital, Huddinge, Institution of Medicine (H7), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Karolina
authors.initials: K
authors.lastname: Szummer
authors.affiliation: Department of Clinical and Experimental Medicine Division of Occupational and Environmental Medicine and Forum Östergötland Faculty of Medicine and Health Sciences, Linköping University, Linköping.
authors.forename: Mats
authors.initials: M
authors.lastname: Fredrikson
authors.affiliation: Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Swahn
mesh_terms: D000368:Aged; D003404:Creatinine / Q000097:blood*; D019317:Evidence-Based Medicine; D005260:Female; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000401:mortality*; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
chemical_list: D003404:Creatinine