Elsevier

American Heart Journal

Volume 160, Issue 6, December 2010, Pages 1065-1071
American Heart Journal

Clinical Investigation
Acute Ischemic Heart Disease
The prognostic importance of worsening renal function during an acute myocardial infarction on long-term mortality

https://doi.org/10.1016/j.ahj.2010.08.007Get rights and content

Background

Although an acute worsening in renal function (WRF) commonly occurs among patients hospitalized for acute myocardial infarction (AMI), its long-term prognostic significance is unknown. We examined predictors of WRF and its association with 4-year mortality.

Methods

Acute myocardial infarction patients from the multicenter PREMIER study (N = 2,098) who survived to hospital discharge were followed for at least 4 years. Worsening in renal function was defined as an increase in creatinine during hospitalization of ≥0.3 mg/dL above the admission value. Correlates of WRF were determined with multivariable logistic regression models and used, along with other important clinical covariates, in Cox proportional hazards models to define the independent association between WRF and mortality.

Results

Worsening in renal function was observed in 393 (18.7%) of AMI survivors. Diabetes, left ventricular systolic dysfunction, and a history of chronic kidney disease (documented history of renal failure with baseline creatinine >2.5 mg/dL) were independently associated with WRF. During 4-year follow-up, 386 (18.6%) patients died. Mortality was significantly higher in the WRF group (36.6% vs 14.4% in those without WRF, P < .001). After adjusting for other factors associated with WRF and long-term mortality, including baseline creatinine, WRF was independently associated with a higher risk of death (hazard ratio = 1.64, 95% CI 1.23-2.19).

Conclusions

Worsening in renal function occurs in approximately 1 of 6 AMI survivors and is independently associated with an adverse long-term prognosis. Further studies on interventions to minimize WRF or to more aggressively treat patients developing WRF should be tested.

Section snippets

Study design

PREMIER was a prospective, multicenter cohort study of AMI patients who survived hospitalization.15 PREMIER enrolled 2,498 AMI patients from 19 US medical centers between January 1, 2003, and June 28, 2004. Patients were ≥18 years old and had an AMI confirmed by elevated biomarkers (troponin or creatine kinase MB) and other supporting evidence of an AMI (≥20 minutes of ischemic signs/symptoms, electrocardiographic ST changes, or both). Eligible patients either presented to the enrolling

Results

Of the 2,098 patients in the cohort, 393 (18.7%) developed WRF. Of these, the majority (n = 307 (78.1%)) had admission creatinine <2 mg/dL, whereas a smaller proportion of patients had admission creatinine of 2 to 3 mg/dL (42 (10.7%)) and 44 (11.1%) of patients had an initial creatinine >3 mg/dL. The median creatinine on admission among patients who later developed WRF was only slightly higher than those who did not (1.2 vs 1.0 mg/dL, P < .001). Patients who developed WRF were more likely to be

Discussion

In this prospective multicenter study of long-term outcomes after AMI, we found that WRF occurred in almost 1 in 6 AMI patients, of whom >75% had creatinine <2.0 mg/dL at admission. When compared with other measures of renal function (admission, maximum, and discharge creatinine), both the strength and magnitude of WRF's association with mortality were stronger than other measures of renal function. In fact, WRF, at a threshold of 0.3 mg/dL, was independently associated with 4-year mortality;

Disclosures

Conflict of interest: none.

Funding sources: The Prospective Registry Evaluating Myocardial Infarction: Events And Recovery (PREMIER) registry study was funded in part by Cardiovascular Therapeutics, 3172 Porter Dr, Palo Alto, CA 94304 and Cardiovascular Outcomes Inc. Drs. Amin and Spertus were funded, in part, by an award from the American Heart Association Pharmaceutical Round Table and David and Stevie Spina.

Acknowledgments

The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper, and its final contents.

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