Premium
The impact of kidney function on outcomes following high risk myocardial infarction: findings from 27 610 patients
Author(s) -
Moukarbel George V.,
Yu ZiFan,
Dickstein Kenneth,
Hou Yingxin Rachel,
Wittes Janet T.,
McMurray John J. V.,
Pitt Bertram,
Zannad Faiez,
Pfeffer Marc A.,
Solomon Scott D.
Publication year - 2014
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.11
Subject(s) - medicine , myocardial infarction , hazard ratio , heart failure , renal function , ejection fraction , cardiology , confidence interval , stroke (engine) , kidney disease , proportional hazards model , creatinine , mechanical engineering , engineering
Aims Renal dysfunction is associated with poor cardiovascular outcome. We investigated the relationship of kidney function and long‐term cardiovascular outcomes in patients with high risk myocardial infarction. Methods and results We studied 27 610 patients from four randomized trials of acute myocardial infarction complicated by heart failure and/or LV dysfunction (LVEF ≤40%). Two trials excluded patients with serum creatinine ≥2.5 mg/dL. Patients were grouped by estimated glomerular filtration rate (eGFR) using the four‐component Modification of Diet in Renal Disease equation. We used adjusted Cox proportional hazard models to compare mortality and composite cardiovascular events among eGFR groups. Median follow‐up was 23 months. The eGFR was approximately normally distributed, with a mean ± SD of 69.1 ± 20.2 mL/min/1.73 m 2 . Co‐morbidities were more prevalent with lower eGFR. The risk of death or composite outcome of cardiovascular death, myocardial infarction, stroke, or heart failure hospitalization increased with declining eGFR. Below 75 mL/min/1.73 m 2 , each 10 unit reduction of eGFR was associated with an adjusted hazard ratio for death of 1.13 (95% confidence interval, 1.11–1.15) and composite cardiovascular outcome of 1.09 (95% confidence interval, 1.08–1.10). Older patients (≥75 years) with low LVEF (<30%) had a higher incidence of mortality and adverse cardiovascular events across eGFR categories. Conclusions Reduced eGFR is strongly and independently associated with poor cardiovascular outcome following high risk myocardial infarction. In these patients, the combination of older age and poor LV systolic function is associated with increased risk of adverse events.