Declining GFR Linked to Mortality Risk After MI

Posted by: admin on: February 23, 2012

Mortality rate increased in Myocardial Infarction patients as kidney function declined. Read on to know more.

Team@CMHF

Patients with chronic kidney disease had a significantly increased risk of death after myocardial infarction, and the risk increased as glomerular filtration rate (GFR) declined, a review of 103,000 myocardial infarction patients showed.

The excess mortality risk ranged from 17% to as much as 500% as the severity of chronic kidney disease (CKD) increased. CKD predicted heightened mortality regardless of the presence or absence of ST-segment elevation.

The mortality risk was attenuated by revascularization procedures across all CKD categories. Ironically, worsening CKD reduced the likelihood of coronary intervention, British investigators reported here at the American Society of Nephrology meeting.

“Further prospective studies are required to clarify the efficacy and effectiveness of revascularization procedures post-MI in populations with renal impairment,” she added.

Despite a high prevalence of CKD in the MI population, patients with renal impairment have been underrepresented in clinical trials, and data on the risks and benefits of revascularization in patients with CKD have been inconclusive. Additionally, studies have shown that renal dysfunction reduces the odds of revascularization.

In an effort to clarify associations among CKD, mortality after MI, and revascularization, Since 2007 the hospitals have measured all MI patients’ serum creatinine at admission.

Investigators reviewed records of MI patients admitted from January 2007 to April 2010. They estimated GFR by means of the CKD-EPI formula, and CKD was defined as a GFR <60 mL/min.

The analysis comprised 41,931 patients with ST-elevation MI (STEMI) and 61,302 patients with non-ST segment elevation MI (NSTEMI).

CKD prevalence was 32.8% in STEMI patients and 50.6% among patients with NSTEMI.

Shaw and colleagues grouped the patients by GFR on admission, using six levels of function from >90 mL/min to <15 mL/min.

In patients with STEMI and NSTEMI, the probability of survival declined with worsening GFR (P<0.0001).

Among patients with NSTEMI and no revascularization procedure, the mortality hazard ratio (HR) increased from 1.23 to 3.38 as GFR declined and from 1.68 to 7.38 in patients who had surgery or percutaneous revascularization.

Similar trends emerged from analyses of patients with STEMI, as the mortality hazard ratio increased from 1.17 to 4.01 with worsening CKD/no intervention and from 1.22 to 4.87 in patients who had revascularization procedures.

Although worsening CKD was associated with lower survival, revascularization improved the odds of survival versus no intervention across all categories of GFR in the STEMI and NSTEMI populations (P<0.0001).

However, the odds of surgery or percutaneous coronary intervention declined significantly as CKD worsened.

Ref: http://www.medpagetoday.com/MeetingCoverage/ASN/29723?utm_source=WC&utm_medium=email&utm_campaign=Meeting_Roundup_ASN

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