Abstract 1526: Presence of Chronic Kidney Disease is Associated with Enhanced Inflammatory Response, Oxidative Stress and Adverse Left Ventricular Remodeling after Reperfused Acute Myocardial Infarction
Background: Patients with chronic kidney disease (CKD) have worse clinical outcome after acute myocardial infarction (AMI). We sought to determine the prognostic significance of CKD in patients with reperfused AMI in relation to left ventricular (LV) remodeling.
Methods: We examined 120 consecutive patients with reperfused first anterior AMI, admitted within 24 hours of the onset. Glomerular filtration rate (GFR) was estimated by MDRD equation using serum creatinine level on admission. Patients with hemodialysis were excluded. Patients were divided into 2 groups according to the presence or absence of CKD, defined as GFR < 60 ml/min/1.73m2. Serum creatine kinase (CK) and C-reactive protein (CRP) levels were serially measured (q. 6, q. 24 hours). Left ventriculography along with plasma interleukin-6 (IL-6) and oxidized low-density lipoprotein (oxLDL) measurements were performed on admission and 2 weeks after AMI. Patients were followed for 27 ± 23 months.
Results: Mean GFR was 74 ± 24 ml/min/1.73m2 and CKD was observed in 25% (n = 30). The prevalence of cardiovascular risk factors, medication and coronary angiographic findings did not differ between the 2 groups. Peak CRP was higher in patients with CKD than those without (p = 0.011), despite similar peak CK. Patients with CKD had higher incidence of in-hospital cardiac death (p = 0.048) and major adverse cardiac events (MACE; p = 0.021), including in- and out-of-hospital cardiac death, non-fatal MI, reintervention, coronary artery bypass grafting and readmission for heart failure, than those without. CKD was associated with greater LV end-diastolic (p = 0.0002) and end-systolic volume (p = 0.0003) and lower LV ejection fraction (p = 0.013) 2 weeks after AMI. Plasma IL-6 (p = 0.037) on admission, and brain natriuretic peptide (p = 0.019) and oxLDL (p = 0.029) 2 weeks after AMI were higher in patients with CKD than in those without. CKD, as well as diabetes mellitus, was an independent predictor of MACE by Cox proportional hazards model analysis (relative risk = 3.13, p = 0.001).
Conclusion: CKD was associated with a worse clinical outcome and infarct expansion through modification of inflammatory response and oxidative stress, suggesting an important role of CKD in the development of LV remodeling after reperfused AMI.