BACKGROUND: There have been no randomized trials of cardioprotective therapy after acute myocardial infarction in patients with chronic kidney disease who should be largely eligible for aspirin (acetylsalicylic acid; ASA) and beta-blockers (BB) as a base of therapy. METHODS: We analyzed a prospective coronary care unit registry of 1724 patients with ST-segment elevation myocardial infarction. RESULTS: Usage rates were 52.3%, 19.0%, 15.2%, and 13.5% for ASA and BB (ASA+BB), BB alone, ASA alone, and no ASA or BB therapy. Patients who received ASA+BB were more likely to be male, free of earlier cardiac disease, and recipients of thrombolysis. Conversely, the absence of ASA+BB was observed in patients with heart failure on admission, left bundle branch block, atrial and ventricular arrhythmias, and shock. The combination of ASA+BB was used in 63.9%, 55.8%, 48.2%, and 35.5% of patients with corrected creatinine clearance values of >81.5, 81.5 to 63.1, 63.1 to 46.2, and <46.2 mL/min/72 kg (P <.0001). ASA+BB was used in 40.4% of patients undergoing dialysis. The age-adjusted relative risk reduction for the inhospital mortality rate was similar among all renal groups and ranged from 64.3% to 80.0% (all P <.0001). CONCLUSION: ASA+BB is an underused therapy in patients with acute myocardial infarction who have underlying kidney disease.
BACKGROUND: There have been no randomized trials of cardioprotective therapy after acute myocardial infarction in patients with chronic kidney disease who should be largely eligible for aspirin (acetylsalicylic acid; ASA) and beta-blockers (BB) as a base of therapy. METHODS: We analyzed a prospective coronary care unit registry of 1724 patients with ST-segment elevation myocardial infarction. RESULTS: Usage rates were 52.3%, 19.0%, 15.2%, and 13.5% for ASA and BB (ASA+BB), BB alone, ASA alone, and no ASA or BB therapy. Patients who received ASA+BB were more likely to be male, free of earlier cardiac disease, and recipients of thrombolysis. Conversely, the absence of ASA+BB was observed in patients with heart failure on admission, left bundle branch block, atrial and ventricular arrhythmias, and shock. The combination of ASA+BB was used in 63.9%, 55.8%, 48.2%, and 35.5% of patients with corrected creatinine clearance values of >81.5, 81.5 to 63.1, 63.1 to 46.2, and <46.2 mL/min/72 kg (P <.0001). ASA+BB was used in 40.4% of patients undergoing dialysis. The age-adjusted relative risk reduction for the inhospital mortality rate was similar among all renal groups and ranged from 64.3% to 80.0% (all P <.0001). CONCLUSION:ASA+BB is an underused therapy in patients with acute myocardial infarction who have underlying kidney disease.
Authors: L Kristin Newby; Manjushri V Bhapkar; Harvey D White; David J Moliterno; Nancy M Allen LaPointe; David E Kandzari; Freek W A Verheugt; Judith M Kramer; Paul W Armstrong; Robert M Califf Journal: J Thromb Thrombolysis Date: 2003-12 Impact factor: 2.300
Authors: Hans-Peter Hobbach; C Michael Gibson; Robert P Giugliano; Julia Hundertmark; Christel Schaeffer; Wassillij Tscherleniak; Peter Schuster Journal: J Thromb Thrombolysis Date: 2003-12 Impact factor: 2.300
Authors: Pamela N Peterson; Amrut V Ambardekar; Philip G Jones; Harlan M Krumholz; Erik Schelbert; John A Spertus; John S Rumsfeld; Frederick A Masoudi Journal: BMC Cardiovasc Disord Date: 2009-07-08 Impact factor: 2.298