Abstract 3479: Insight From the National Registry of Myocardial Infarction on the Outcomes of Patients with Elevated Serum Creatinine Level at Hospital Admission with Acute Myocardial Infarction
Background/Methods: Renal failure (RF) carries poor prognosis in Acute Myocardial Infarction (AMI). To determine the magnitude of inhospital outcomes in AMI patients with RF at hospital admission, we compared patients with serum creatinine (SC) >1.5mg/dl to those with SC ≥1.5mg/dl (NRF) enrolled in the National Registry of Myocardial Infarction 5.
Results: Out of a total 84,985 patients, (19,796 RF and 65,189 NRF), RF patients had more often history of hypertension, MI, heart failure, diabetes, stroke, peripheral vascular disease (PVD), pulmonary edema, and less often received ACE inhibitors, beta blockers, aspirin, clopidogrel, statin, GP 2b/3a inhibitors and revascularization. RF patients had higher inhospital death (OR 1.98; 95% CI 1.84–2.13) and major adverse cardiac events (MACE) (OR 1.39; 95% CI 1.32–1.47). Independent predictors of inhospital death in RF were ST elevation MI, ST depression, left bundle branch block, heart failure, history of stroke, PVD, diabetes and age, and those for MACE were presence of ST elevation, ST depression, heart failure, history of angina, coronary revascularization, stroke and PVD. Among RF patients, inhospital death and MACE rates were lower in those who received ACE inhibitors, beta blockers, aspirin, clopidogrel and statin but higher in those given diuretics and GP 2b/3a inhibitors. As shown in figure⇓, MACE and inhospital death were more in moderate RF patients.
Conclusion: Renal failure at hospital admission results in poorer outcomes in patients with acute myocardial infarction. They were sicker and less aggressively treated than patients with normal renal function. Worst outcomes were seen moderate renal dysfunction patients.