Clinical InvestigationAcute Ischemic Heart DiseaseThe prognostic importance of worsening renal function during an acute myocardial infarction on long-term mortality
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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