Abstract 3477: Increase in Creatinine and Cardiovascular Risk in Patients with Systolic Dysfunction after Myocardial Infarction
Background: Baseline renal function is a potent independent risk factor for adverse events after acute myocardial infarction (MI). Worsening renal function (WRF) has been shown to influence outcomes in the heart failure population, but its impact on cardiovascular risk in the post-MI period has not been well-defined.
Methods: To assess the prognostic importance of WRF, we studied 2231 subjects with left ventricular dysfunction enrolled in the Survival and Ventricular Enlargement (SAVE) trial. Subjects were randomized between 3–16 days (average 11 days) after acute MI to receive captopril or placebo; those with a serum creatinine above 2.5mg/dl were excluded from SAVE. WRF was defined as an increase in creatinine greater-than 0.3mg/dl measured from baseline to two weeks after randomization. We examined the predictive value of WRF on cardiovascular morbidity and mortality over 42 months of follow-up.
Results: Paired serum creatinine measurements at baseline and two weeks were available in 1854 subjects. WRF occurred in 223 subjects (12.0%), and was a stronger predictor of death (HR 1.46, 95%CI 1.05–2.02) than baseline creatinine (HR 1.31, 95%CI 1.01–1.70). WRF also showed increased risk for cardiovascular death (HR 1.62, 95%CI 1.14–2.30) and the composite endpoint (HR 1.32, 95%CI 1.03–1.70). When stratified by treatment, there were 104 (5.7%) and 116 (6.4%) with WRF in the placebo and captopril groups with no significant association between treatment group and WRF (p=0.38). The risk of death associated with WRF was (HR 1.63, 1.05–2.52) in the placebo group compared to (HR 1.33, 0.81–2.21) the captopril group (p for interaction=0.49).
Conclusions: WRF as early as two weeks after myocardial infarction was not uncommon (12.0%), and was associated with increased mortality in subjects without renal dysfunction at baseline. Patients who received captopril did not demonstrate more WRF than patients receiving placebo. Monitoring serum creatinine in patients during the first few weeks after myocardial infarction may help identify those at highest risk and guide effective long-term therapeutic choices.