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

Wright, R. Scott; Reeder, Guy S.; Herzog, Charles A.; Albright, Robert C.; Williams, Brent A.; Dvorak, David M.; Miller, Wayne L.; Murphy, Joseph G.; Kopecky, Stephen L.; Jaffe, Allan S.

doi:10.7326/0003-4819-137-7-200210010-00007

Cited by 548 publications

(399 citation statements)

References 17 publications

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“…For CV mortality, all-cause mortality, and heart failure-related hospitalization, the risk reduction was greater for subjects with reduced kidney function. 8 Wright et al 6 reported a reduced risk of in-hospital death if patients were treated (nonrandomized) with ACE inhibitors; however, the authors indicated that the use of ACE inhibitors during index hospitalization was lower in patients with CKD. Data from the Cooperative Cardiovascular Project, which included older patients with MI, showed that ACE inhibitors were used more frequently in patients with CKD than in patients with no renal insufficiency and were associated with enhanced survival.…”

Section: ϫ2mentioning

confidence: 97%

Chronic Kidney Disease, Cardiovascular Risk, and Response to Angiotensin-Converting Enzyme Inhibition After Myocardial Infarction

et al. 2004

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Background-Persons with end-stage renal disease and those with lesser degrees of chronic kidney disease (CKD) have an increased risk of death after myocardial infarction (MI) that is not fully explained by associated comorbidities. Future cardiovascular event rates and the relative response to therapy in persons with mild to moderate CKD are not well characterized. Methods and Results-We calculated the estimated glomerular filtration rate (eGFR) using the 4-variable Modification of Diet in Renal Disease method in 2183 Survival And Ventricular Enlargement (SAVE) trial subjects. SAVE randomized post-MI subjects (3 to 16 days after MI) with left ventricular ejection fraction Յ40% and serum creatinine Ͻ2.5 mg/dL to captopril or placebo. Cox proportional hazards models were used to evaluate the relative hazard rates for death and cardiovascular events associated with reduced eGFR. Subjects with reduced eGFR were older and had more extensive comorbidities. The multivariable adjusted risk ratio for total mortality associated with reduced eGFR from 60 to 74, 45 to 59, and Ͻ45 mL · min Ϫ1 · 1.73 m Ϫ2 (compared with eGFR Ն75 mL · min Ϫ1 · 1.73 m

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Section: ϫ2mentioning

confidence: 97%

Chronic Kidney Disease, Cardiovascular Risk, and Response to Angiotensin-Converting Enzyme Inhibition After Myocardial Infarction

et al. 2004

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“…Moreover, although ␤-adrenergic blockers and ACE inhibitors improve survival in patients after AMI, 37 these agents are often underused in patients with RI compared with those with normal renal function. 4,38,39 All attempts must be made to prevent contrast nephropathy, including adequate hydration, 40 minimizing contrast use, 29 use of low-osmolar contrast, 41 and possibly administration of N-acetylcysteine. 42 Patients with baseline RI warrant close surveillance and intensive medical management, including tight control of diabetes, hypertension, and dyslipidemia 20 ; dietary modification; and potentially frequent stress testing for early recognition of disease progression.…”

Section: Discussionmentioning

confidence: 99%

Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

et al. 2003

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Background-The prognostic importance of renal insufficiency (RI) in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) has not been well characterized. Methods and Results-PCI was performed in 2082 AMI patients without shock presenting within 12 hours of symptom onset in a prospective, multicenter randomized trial. RI was defined as a calculated (Cockroft-Gault) creatinine clearance (CrCl) Յ60 mL/min. RI at baseline was present in 18% of patients. Compared with patients without RI, patients with RI were older and were more likely to be female; to have hypertension, peripheral vascular disease, or cerebrovascular disease; and to present in heart failure. Mortality was markedly increased in patients with versus without baseline RI both at 30 days (7.5% versus 0.8%, PϽ0.0001) and at 1 year (12.7% versus 2.4%, PϽ0.0001). Mortality rates increased incrementally for every 10-mL/min decrease in baseline CrCl. By multivariate analysis, reduced baseline CrCl was a powerful independent predictor of 30-day mortality (hazard ratio, 5.77; PϽ0.0001) and remained associated with reduced survival at 1 year (hazard ratio, 1.98; Pϭ0.08). Hemorrhagic complications and transfusion requirements were also increased more than 2-fold in patients with RI, as were severe restenosis (diameter stenosis Ն70%; 20.6% versus 11.8%, Pϭ0.024) and infarct artery reocclusion (14.7% versus 7.3%, Pϭ0.02). Conclusions-Baseline RI in patients with AMI undergoing primary PCI is associated with a markedly increased risk of mortality, as well as bleeding and restenosis. Novel approaches are needed to improve the otherwise poor prognosis of patients with RI and AMI.

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“…Unfortunately, several studies have shown that CKD patients, with documented CHD, do not receive optimal treatment with aspirin, beta-blockers, ACE inhibitors, statins etc. [31,32]. Similarly, patients with CVD do not always receive optimal preventive therapy [33].…”

Section: Discussionmentioning

confidence: 99%

Prognostic implications of renal dysfunction in patients with stable angina pectoris

Almquist

Forslund

Rehnqvist

et al. 2006

Journal of Internal Medicine

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Objective. Impaired renal function is emerging as an independent risk factor for cardiovascular (CV) disease. We analysed the prognostic implications of estimated renal function in patients with angina pectoris. Design. Post hoc analysis of the Angina Prognosis Study In Stockholm (APSIS). The estimated creatinine clearance (eCrCl) was calculated according to the Cockcroft-Gault formula in 808 patients. Outcomes were compared for subgroups with CrCl ‡90, 60-89 and<60 mL min )1 . Setting. Hospital-based study with patients referred from primary care and hospital. Subjects. A total of 809 patients (248 women) with clinically diagnosed stable angina pectoris. Intervention. Double-blind treatment with metoprolol or verapamil.Results. One hundred and sixty-four patients (91 women) had an eCrCl below 60 mL min )1 . During a median follow-up of 40 months, 38 patients suffered CV death and 31 patients had a nonfatal myocardial infarction (MI). In a univariate analysis a lower eCrCl was related to a higher risk for CV death or MI amongst men (log rank P ¼ 0.036). A multivariate Cox analysis showed an independent prognostic importance of eCrCl for CV death (P ¼ 0.046) and for CV death or MI (P ¼ 0.042) amongst all patients. When analysed as a continuous variable, a 1 mL min )1 decrease in eCrCl was associated with a 1.6% (0.1-3.1) increase in the risk for CV death or MI, and a 2.1% (0-4.1) increase in the risk for CV death alone. Conclusion. Renal dysfunction was found to be common in patients with stable angina pectoris and estimated creatinine clearances carried significant independent prognostic information regarding CV death and nonfatal MI.

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

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

Cited by 548 publications

References 17 publications

Chronic Kidney Disease, Cardiovascular Risk, and Response to Angiotensin-Converting Enzyme Inhibition After Myocardial Infarction

Chronic Kidney Disease, Cardiovascular Risk, and Response to Angiotensin-Converting Enzyme Inhibition After Myocardial Infarction

Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

Prognostic implications of renal dysfunction in patients with stable angina pectoris

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