Acute Myocardial Infarction and Renal Dysfunction: A High-Risk Combination

  1. R. Scott Wright, MD;
  2. Guy S. Reeder, MD;
  3. Charles A. Herzog, MD;
  4. Robert C. Albright, DO;
  5. Brent A. Williams, MS;
  6. David L. Dvorak, RN;
  7. Wayne L. Miller, MD;
  8. Joseph G. Murphy, MD;
  9. Stephen L. Kopecky, MD; and
  10. Allan S. Jaffe, MD
  1. From Mayo Clinic, Rochester, and University of Minnesota Medical School and Hennepin County Medical Center, Minneapolis, Minnesota.

    Abstract

    Background: Survival is poor in patients with acute myocardial infarction (MI) who also have severe renal disease. Less is known about the outcome of acute MI in patients with mild to moderate renal insufficiency.

    Objective: To compare outcomes after acute MI in patients with varying levels of renal disease and in patients without renal failure.

    Design: Retrospective cohort study.

    Setting: Academic medical center.

    Patients: 3106 total patients admitted with acute MI and end-stage renal disease (n = 44), severe renal insufficiency (creatinine clearance < 0.59 mL/s [<35 mL/min]) (n = 391), moderate renal dysfunction (creatinine clearance ≥ 0.59 mL/s [<35 mL/min] but ≤ 0.84 mL/s [≤ 50 mL/min]) (n = 491), mild chronic renal insufficiency (creatinine clearance > 0.84 mL/s [>50 mL/min] but ≤ 1.25 mL/s [≤ 75 mL/min]) (n = 860), or no renal disease (n = 1320).

    Measurements: Clinical characteristics, treatment strategies, and short- and long-term survival were compared after patients were stratified by creatinine clearance.

    Results: In-hospital mortality rates were 2% in patients with normal renal function, 6% in those with mild renal failure, 14% in those with moderate renal failure, 21% in those with severe renal failure, and 30% in those with end-stage renal disease (P < 0.001). Compared with patients without renal disease, similar adjusted trends were present for postdischarge death in patients with end-stage renal disease (hazard ratio, 5.4 [95% CI, 3.0 to 9.7]; P < 0.001), severe renal insufficiency (hazard ratio, 1.9 [CI, 1.2 to 3.0]; P = 0.006), moderate renal dysfunction (hazard ratio, 2.2 [CI, 1.5 to 3.3]; P < 0.001), and mild chronic renal insufficiency (hazard ratio, 2.4 [CI, 1.7 to 3.3]; P < 0.001). Patients with renal failure received adjunctive and reperfusion therapies less frequently than those with normal renal function (P < 0.001). Postdischarge death was less likely in patients who received acute reperfusion therapy (odds ratio, 0.7 [CI, 0.6 to 0.9]), aspirin (odds ratio, 0.7 [CI, 0.5 to 0.8]), and β-blocker therapy (odds ratio, 0.7 [CI, 0.6 to 0.9]).

    Conclusion: Patients with renal failure are at increased risk for death after acute MI and receive less aggressive treatment than patients with normal renal function.

    Article and Author Information

    • Acknowledgment: The authors thank Amy Oeltjen for excellent administrative work.

    • Grant Support: By the Mayo Foundation and the Mayo Alliance for Clinical Trials.

    • Requests for Single Reprints: R. Scott Wright, MD, Division of Cardiology, Mayo Clinic, Mayo Alliance for Clinical Trials, Stabile 5, 150 Third Street SW, Rochester, MN 55902; e-mail, wright.scott{at}mayo.edu.

    • Potential Financial Conflicts of Interest:Consultancies: C.A. Herzog, A.S. Jaffe; Grants received: R.S. Wright, C.A. Herzog, A.S. Jaffe; Grants pending: A.S. Jaffe.

    • Current Author Addresses: Drs. Wright and Kopecky and Mr. Dvorak: Division of Cardiology, Mayo Alliance for Clinical Trials, Mayo Clinic, Stabile 5, 150 Third Street SW, Rochester, MN 55902.

    • Drs. Reeder, Miller, Murphy, and Jaffe: Division of Cardiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

    • Dr. Herzog: Hennepin County Medical Hospital—Cardiology, 701 Park Avenue, Mail Station 865A, Minneapolis, MN 55415.

    • Dr. Albright: Division of Nephrology, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905.

    • Mr. Williams: Division of Biostatistics, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905.

    • Author Contributions: Conception and design: R.S. Wright, C.A. Herzog, S.L. Kopecky.

    • Analysis and interpretation of the data: R.S. Wright, G.S. Reeder, R.C. Albright, B.A. Williams, W.L. Miller, J.G. Murphy, S.L. Kopecky, A.S. Jaffe.

    • Drafting of the article: R.S. Wright, G.S. Reeder, R.C. Albright, W.L. Miller, J.G. Murphy, A.S. Jaffe.

    • Critical revision of the article for important intellectual content: R.S. Wright, G.S. Reeder, C.A. Herzog, R.C. Albright, W.L. Miller, J.G. Murphy, S.L. Kopecky, A.S. Jaffe.

    • Final approval of the article: R.S. Wright, G.S. Reeder, R.C. Albright, B.A. Williams, W.L. Miller, J.G. Murphy, S.L. Kopecky, A.S. Jaffe.

    • Provision of study materials or patients: D.L. Dvorak, S.L. Kopecky.

    • Statistical expertise: B.A. Williams, A.S. Jaffe.

    • Obtaining of funding: R.S. Wright, S.L. Kopecky.

    • Collection and assembly of data: B.A. Williams, D.L. Dvorak, A.S. Jaffe.

    Summary for Patients

    • Summaries for Patients:The Influence of Kidney Disease on Outcomes of Patients with Heart Attack Ann Intern Med October 1, 2002 137:I-22
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    1. Ann Intern Med October 1, 2002 vol. 137 no. 7 563-570
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