Renal failure and acute myocardial infarction: Clinical characteristics in patients with advanced chronic kidney disease, on dialysis, and without chronic kidney disease. A collaborative project of the United States Renal Data System/National Institutes of Health and the National Registry of Myocardial Infarction

Gautam R. Shroff, Paul D. Frederick, Charles A. Herzog

Research output: Contribution to journalArticlepeer-review

67 Scopus citations

Abstract

Background: Patients with chronic kidney disease (CKD) experience poor outcomes after acute myocardial infarction (AMI). We sought to compare clinical characteristics of advanced CKD, dialysis, and non-CKD patients hospitalized with AMI. Methods: This observational study used record-linked data from the US Renal Data System and Third National Registry of Myocardial Infarction to identify 2,390 dialysis patients with AMI hospitalizations between April 1998 and June 2000. Advanced CKD patients (n = 29,319) were identified by baseline creatinine level ≥2.5 mg/dL. Clinical characteristics of CKD, dialysis, and non-CKD patients (n = 274,777) were compared using the χ 2 test. Results: Clinically significant differences among patients with advanced CKD (dialysis and non-CKD, respectively) on admission were chest pain, 40.4% (41.1% and 61.6%); diagnosis other than acute coronary syndrome, 44% (47.7% and 25.8%); and ST elevation, 15.9% (17.6% and 32.5%). In-hospital adverse outcomes were mortality, 23% (21.7% and 12.6%); unexpected cardiac arrest, 8.9% (12.3% and 6%); congestive heart failure, 41% (25.8% and 21.1%); and major bleeding, 4.9% (4.4% and 3%); P <.001 for all comparisons. In a logistic regression model, the adjusted odds ratio for in-hospital mortality for CKD (vs non-CKD) patients was 1.44 (95% CI 1.39-1.49). Conclusions: The clinical characteristics of non-dialysis-dependent, advanced CKD patients with AMI are similar to characteristics of dialysis patients and likely contribute to poor outcomes. Intensive efforts for timely, accurate recognition of AMI in advanced CKD patients are warranted.

Original languageEnglish (US)
Pages (from-to)399-406
Number of pages8
JournalAmerican Heart Journal
Volume163
Issue number3
DOIs
StatePublished - Mar 2012

Bibliographical note

Funding Information:
Paul Frederick is employed by ICON Clinical Research, a contract research organization that receives research funding from Genentech, Inc. The other authors report no conflicts of interest. The authors thank US Renal Data System colleagues Shane Nygaard, BA, for manuscript preparation, and Nan Booth, MSW, MPH, ELS, for manuscript editing.

Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.

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