Original Investigation
Pathogenesis and Treatment of Kidney Disease
GFR and Cardiovascular Outcomes After Acute Myocardial Infarction: Results From the Korea Acute Myocardial Infarction Registry

https://doi.org/10.1053/j.ajkd.2012.01.016Get rights and content

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.

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).

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 m2.

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.

Results

Mean eGFR was 72.8 ± 24.6 mL/min/1.73 m2, 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 m2, patients with eGFR of 30-59, 15-29, and <15 mL/min/1.73 m2 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.

Limitations

Single assessment of serum creatinine.

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.

Section snippets

Korea AMI Registry

The Korea AMI Registry (KAMIR) is a prospective multicenter online registry designed to describe characteristics and clinical outcomes of patients with AMI and reflects current management of patients with AMI in Korea. The registry included 52 community and university hospitals with the capability of primary percutaneous coronary intervention (PCI). Data were collected retrospectively at each site by a trained study coordinator based on a standardized protocol. We analyzed the enrolled data to

Baseline Characteristics

A total of 12,636 patients were included in the present study; 3,491 (27.6%) patients with eGFR >90 mL/min/1.73 m2; 5,791 (45.8%) with eGFR of 60-89 mL/min/1.73 m2; 2,609 (20.6%) with eGFR of 30-59 mL/min/1.73 m2; 439 (3.5%) with eGFR of 15-29 mL/min/1.73 m2; and 306 (2.4%) with eGFR <15 mL/min/1.73 m2; 61.6% had STEMI; and 39.4% had NSTEMI. Table 1 lists baseline characteristics of patients by eGFR category at baseline. Overall, median follow-up was 404 days, mean age was 64 years, 70.4% were

Discussion

Cardiovascular disease in patients with CKD is common and has major implications in terms of both human suffering and health care cost. The present study evaluated prognostic factors and clinical outcomes of patients experiencing AMI by eGFR level. Interestingly, STEMI was more common in patients with higher eGFR category, whereas the prevalence of NSTEMI was higher in patients with lower eGFR category, as previously shown by others.16 These findings may suggest that loss of kidney function is

Acknowledgements

Support: This research was supported by Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (2010-0008732), and by the Korea Science and Engineering Foundation through the Medical Research Center for Gene Regulation (grant 2011-0030732) at Chonnam National University.

Financial Disclosure: The authors declare that they have no other relevant financial interests.

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    Originally published online March 26, 2012.

    E.H.B. and S.Y.L. contributed equally to this work.

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