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GFR and cardiovascular outcomes after acute myocardial infarction: results from the Korea Acute Myocardial Infarction Registry.
- Source :
-
American journal of kidney diseases : the official journal of the National Kidney Foundation [Am J Kidney Dis] 2012 Jun; Vol. 59 (6), pp. 795-802. Date of Electronic Publication: 2012 Mar 23. - Publication Year :
- 2012
-
Abstract
- Background: Despite strong evidence linking decreased glomerular filtration rate (GFR) to worse outcomes, the impact of GFR on mortality and morbidity in patients with acute myocardial infarction (AMI) is not well defined.<br />Study Design: Retrospective cohort study.<br />Setting & Participants: 12,636 patients with AMI in the Korea AMI Registry database from November 2005 to July 2008. 93% of patients in this registry had coronary angiography, and 91% of patients with coronary angiography had percutaneous coronary intervention (PCI).<br />Predictor: GFR was estimated (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, and patients were grouped into 5 eGFR categories: >90, 60-89, 30-59, 15-29, and <15 mL/min/1.73 m(2).<br />Outcomes: Primary end points were death and in-hospital complications. Secondary end points were major adverse cardiac events (MACEs) during a 1-month (short-term) and 1-year (long-term) follow-up after AMI.<br />Results: Mean eGFR was 72.8 ± 24.6 mL/min/1.73 m(2), mean age was 64 ± 13 years, and 70.4% were men. A graded association was observed between eGFR and clinical outcomes. In adjusted analyses, compared with eGFR >90 mL/min/1.73 m(2), patients with eGFR of 30-59, 15-29, and <15 mL/min/1.73 m(2) experienced increased risks of short- (respective HRs of 2.30 [95% CI, 1.70-3.11], 3.10 [95% CI, 2.14-4.14], and 3.64 [95% CI, 2.44-5.43]; P < 0.001) and long-term MACEs (HRs of 1.58 [95% CI, 1.32-1.90], 2.12 [95% CI, 1.63-2.75], and 2.50 [95% CI, 1.89-3.29]; P < 0.001). Older age, Killip class higher than I, PCI, and high-sensitivity C-reactive protein level also were associated with higher short- and long-term MACEs. Use of β-blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), and statins was associated with decreased risk of MACEs.<br />Limitations: Single assessment of serum creatinine.<br />Conclusion: eGFR was associated independently with mortality and complications after AMI. PCI, β-blocker, ACE inhibitor or ARB, and statin use were associated with decreased risks of short- and long-term MACEs.<br /> (Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Angioplasty, Balloon, Coronary methods
Cohort Studies
Coronary Angiography
Female
Follow-Up Studies
Humans
Kidney Function Tests
Korea
Male
Middle Aged
Myocardial Infarction therapy
Predictive Value of Tests
Registries
Renal Insufficiency, Chronic mortality
Renal Insufficiency, Chronic therapy
Retrospective Studies
Risk Assessment
Severity of Illness Index
Survival Rate
Treatment Outcome
Angioplasty, Balloon, Coronary mortality
Cause of Death
Glomerular Filtration Rate physiology
Myocardial Infarction diagnosis
Myocardial Infarction mortality
Renal Insufficiency, Chronic diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1523-6838
- Volume :
- 59
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- American journal of kidney diseases : the official journal of the National Kidney Foundation
- Publication Type :
- Academic Journal
- Accession number :
- 22445708
- Full Text :
- https://doi.org/10.1053/j.ajkd.2012.01.016