Vishal Vashistha1, Meng Lee2, Yi-Ling Wu3, Sukhdeep Kaur4, Bruce Ovbiagele5. 1. Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: vashisv@ccf.org. 2. Department of Neurology, Chang-Gung University College of Medicine, Chiayi, Taiwan. Electronic address: menglee5126@gmail.com. 3. Department of Neurology, Chang-Gung University College of Medicine, Chiayi, Taiwan. Electronic address: wyling83@hotmail.com. 4. Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: sukhdeep.bahad@gmail.com. 5. Department of Neurology and Neurosurgery, College of Medicine, Medical University of South Carolina, Charleston, SC, USA. Electronic address: ovibes@musc.edu.
Abstract
BACKGROUND: Chronic kidney disease is increasing in prevalence. The association between low baseline estimated glomerular filtration rate (eGFR) and future myocardial infarction has not been comprehensively assessed. METHODS: A systematic review and meta-analysis of observational studies evaluating the risk for future myocardial infarction associated with eGFR <60 and 60-90ml/min/1.73m2 was completed. Data sources included PubMed, EMBASE, and the Cochrane Library. Included studies were required to have prospectively collected data, followed subjects for at least 6months, and reported baseline eGFR levels and the multivariable-adjusted relative risk for future myocardial infarction. A random effects model was used and subgroup analyses were conducted. RESULTS: 26 publications representing 41 observational cohorts were selected. In total, 1,986,850 participants with more than 35,752 documented myocardial infarctions (follow-up range: 9months to ~20years) were evaluated. eGFR <60ml/min/1.73m2 was associated with a relative risk of 1.52 (95% confidence interval 1.39-1.67; p<0.00001) while eGFR 60-90ml/min/1.73m2 was associated with a relative risk of 1.21 (1.09-1.34; p=0.0002) for myocardial infarction. Significant heterogeneity existed among both eGFR groups. Subgroup analysis found a further increase in risk for myocardial infarction as eGFR declined from 30 to 60 to <30ml/min/1.73m2 (1.40, 95% confidence interval, 1.21-1.61 vs.1.94, 95% confidence interval, 1.51-2.50; p=0.03). CONCLUSIONS: Decreased baseline eGFR is independently associated with increased future myocardial infarction, and the risk increases with advanced renal insufficiency. Clinicians should be wary of acute coronary syndromes in patients with CKD. Published by Elsevier Ireland Ltd.
BACKGROUND:Chronic kidney disease is increasing in prevalence. The association between low baseline estimated glomerular filtration rate (eGFR) and future myocardial infarction has not been comprehensively assessed. METHODS: A systematic review and meta-analysis of observational studies evaluating the risk for future myocardial infarction associated with eGFR <60 and 60-90ml/min/1.73m2 was completed. Data sources included PubMed, EMBASE, and the Cochrane Library. Included studies were required to have prospectively collected data, followed subjects for at least 6months, and reported baseline eGFR levels and the multivariable-adjusted relative risk for future myocardial infarction. A random effects model was used and subgroup analyses were conducted. RESULTS: 26 publications representing 41 observational cohorts were selected. In total, 1,986,850 participants with more than 35,752 documented myocardial infarctions (follow-up range: 9months to ~20years) were evaluated. eGFR <60ml/min/1.73m2 was associated with a relative risk of 1.52 (95% confidence interval 1.39-1.67; p<0.00001) while eGFR 60-90ml/min/1.73m2 was associated with a relative risk of 1.21 (1.09-1.34; p=0.0002) for myocardial infarction. Significant heterogeneity existed among both eGFR groups. Subgroup analysis found a further increase in risk for myocardial infarction as eGFR declined from 30 to 60 to <30ml/min/1.73m2 (1.40, 95% confidence interval, 1.21-1.61 vs.1.94, 95% confidence interval, 1.51-2.50; p=0.03). CONCLUSIONS: Decreased baseline eGFR is independently associated with increased future myocardial infarction, and the risk increases with advanced renal insufficiency. Clinicians should be wary of acute coronary syndromes in patients with CKD. Published by Elsevier Ireland Ltd.
Authors: Irene Capelli; Lorenzo Gasperoni; Marco Ruggeri; Gabriele Donati; Olga Baraldi; Giovanni Sorrenti; Maria Turchese Caletti; Valeria Aiello; Giuseppe Cianciolo; Gaetano La Manna Journal: J Nephrol Date: 2019-04-15 Impact factor: 3.902
Authors: Leandro Teixeira de Castro; Itamar de Souza Santos; Alessandra C Goulart; Alexandre da Costa Pereira; Henrique Lane Staniak; Marcio Sommer Bittencourt; Paulo Andrade Lotufo; Isabela Martins Bensenor Journal: Arq Bras Cardiol Date: 2019-01-07 Impact factor: 2.000