BACKGROUND: Cardiovascular mortality is high in individuals with end-stage renal disease. However, less is known about the prognostic importance of moderate renal insufficiency in patients with acute myocardial infarction. METHODS: We studied all patients with acute myocardial infarction admitted through the emergency department to an urban, academic hospital over 1 year. Patients were classified as having elevated (>133 micromol/L [1.5 mg/dL]) or normal (< or =133 micromol/L) serum creatinine at presentation. RESULTS: Of 483 patients, 22% had elevated creatinine and 78% had normal creatinine. By 1 year, 46% of patients with elevated creatinine and 15% of patients with normal creatinine had died (P <.001). The unadjusted hazard ratio for 1-year mortality was increased in patients with elevated creatinine compared with those with normal creatinine (hazard ratio 3.85, 95% CI 2.61-5.67). After adjustment for baseline characteristics and treatment, the multivariable-adjusted hazard ratio for 1-year mortality remained increased in patients with elevated creatinine compared with those with normal creatinine (hazard ratio 2.40, 95% CI 1.55-3.72). There was an important modification of the prognostic value of creatinine by the presence of congestive heart failure at presentation (P value for interaction =.04). The adjusted hazard ratio for 1-year death associated with elevated creatinine compared with normal creatinine was 3.89 (95% CI 1.87-8.07) in patients without congestive heart failure and 1.92 (95% CI 1.10-3.36) in patients with congestive heart failure. CONCLUSIONS: Elevated serum creatinine at presentation is associated with 1-year mortality after acute myocardial infarction. Further study is needed to optimize treatment after myocardial infarction in this high-risk group.
BACKGROUND: Cardiovascular mortality is high in individuals with end-stage renal disease. However, less is known about the prognostic importance of moderate renal insufficiency in patients with acute myocardial infarction. METHODS: We studied all patients with acute myocardial infarction admitted through the emergency department to an urban, academic hospital over 1 year. Patients were classified as having elevated (>133 micromol/L [1.5 mg/dL]) or normal (< or =133 micromol/L) serum creatinine at presentation. RESULTS: Of 483 patients, 22% had elevated creatinine and 78% had normal creatinine. By 1 year, 46% of patients with elevated creatinine and 15% of patients with normal creatinine had died (P <.001). The unadjusted hazard ratio for 1-year mortality was increased in patients with elevated creatinine compared with those with normal creatinine (hazard ratio 3.85, 95% CI 2.61-5.67). After adjustment for baseline characteristics and treatment, the multivariable-adjusted hazard ratio for 1-year mortality remained increased in patients with elevated creatinine compared with those with normal creatinine (hazard ratio 2.40, 95% CI 1.55-3.72). There was an important modification of the prognostic value of creatinine by the presence of congestive heart failure at presentation (P value for interaction =.04). The adjusted hazard ratio for 1-year death associated with elevated creatinine compared with normal creatinine was 3.89 (95% CI 1.87-8.07) in patients without congestive heart failure and 1.92 (95% CI 1.10-3.36) in patients with congestive heart failure. CONCLUSIONS: Elevated serum creatinine at presentation is associated with 1-year mortality after acute myocardial infarction. Further study is needed to optimize treatment after myocardial infarction in this high-risk group.
Authors: Ingo Wickenbrock; Christian Perings; Petra Maagh; Ivo Quack; Marc van Bracht; Magnus W Prull; Gunnar Plehn; Hans-Joachim Trappe; Axel Meissner Journal: Clin Res Cardiol Date: 2009-10-23 Impact factor: 5.460
Authors: Doo Hwan Lee; Myung Ho Jeong; Jung Ae Rhee; Jin Su Choi; Ki Hong Lee; Min Goo Lee; Doo Sun Sim; Keun-Ho Park; Nam Sik Yoon; Hyun Ju Yoon; Kye Hun Kim; Hyung Wook Park; Young Joon Hong; Ju Han Kim; Youngkeun Ahn; Jeong Gwan Cho; Jong Chun Park; Jung Chaee Kang Journal: Korean Circ J Date: 2012-10-31 Impact factor: 3.243
Authors: Thomas Kümler; Gunnar H Gislason; Lars Kober; Finn Gustafsson; Morten Schou; Christian Torp-Pedersen Journal: BMC Cardiovasc Disord Date: 2011-06-27 Impact factor: 2.298
Authors: Min Jee Kim; Hong Sang Choi; Seul Hyun Oh; Hyung Chul Lee; Chang Seong Kim; Joon Seok Choi; Jeong Woo Park; Eun Hui Bae; Seong Kwon Ma; Nam Ho Kim; Myung Ho Jeong; Soo Wan Kim Journal: Yonsei Med J Date: 2011-07 Impact factor: 2.759