The importance of chronic kidney disease for the assessment of risk of adverse outcomes after myocardial infarction

Abstract

Renal dysfunction (RD) in the acute phase of myocardial infarction (MI) is pivotal for the risk stratification of adverse long-term outcomes after myocardial infarction and, therefore, requires further study. Purpose. To determine the role of CKD and renal dysfunction (in the acute phase of MI) in the adverse long-term post-MI prognosis. Material and methods. 954 patients with ST-segment elevation myocardial infarction (STEMI) were enrolled in a registry study, performed in the period from 2008 to 2010 at the Kemerovo Cardiology Dispensary. All patients were assigned to two groups according to the presence of concomitant CKD. Serum creatinine levels were measured at the time of admission and on 10-12th days, with further calculation of glomerular filtration rate (GFR) using the CKD-EPI equation. Patients without CKD were assigned to Group I (n = 616 (64.5%), and STEMI patients with CKD to Group II (n=338 (35.4%). Observations during the three-year follow-up period were evaluated from the end-points. Results. The factors associated with mortality among patients with CKD were as follows: left ventricular ejection fraction (LVEF) < 40% at the time of admission (OR 2.1; 95% CI 1.0-4.4), signs of RD at the time of discharge (OR 2.5, 95% CI 1.0-5.9), non-performance of myocardial revascularization (OR 3.1, 95% CI 1.4-6.8). The long-term prognosis in the group of patients without CKD depended on the following factors: non-performance of PCI (OR 2.1, 95% CI 1.0-4.3), severe AHF (Killip class) (OR 3.5, 95% CI 1.9-6.7), LVEF < 40% (OR 2.0, 95% CI 1.0-3.8), and older age (OR 2.0, 95% CI 1.0-3.9). Conclusion. Renal dysfunction (regardless of the presence of CKD) diagnosed in the acute phase of MI as well as left ventricular dysfunction (EF < 40%) were found to affect long-term mortality risk in the post-MI period.