Abstract 5579: Myocardial Infarction, Clinical Characteristics and Prognosis across Five Renal Function Stages - Data from the Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA)
Assess clinical characteristics, presentation and prognosis following a myocardial infarction (MI) at different degrees of renal insufficiency. Nearly all consecutive patients in Sweden with MI treated at a coronary care unit between 2003–2006 and who had either known creatinine or received dialysis (n=58496, 90.4% of entire cohort) were followed. Glomerular filtration rate (eGFR) was estimated with the Modification of Diet in Renal Disease formula and staged according to the National Kidney Foundation definition. Cox regression analysis adjusting for 30 variables including baseline characteristics, symptoms on admission, ECG-pattern, reperfusion therapy and discharge medication was used to assess mortality with eGFR both as a continuous and categorical variable. Patients with declining renal function differed by being older and having more comorbidites such as diabetes, hypertension and prior MI. Fewer patients with kidney failure presented with chest pain compared to those with normal eGFR≥90 ml/min/m2 (66.2% versus 90.2%). They had a non-ST-elevation MI more often (67.7% versus 55.7%) and clinical heart failure (45.0% versus 10.7%) on admission. Overall, at 30 days and 1 year, 8.5% and 16.4% patients had died. After adjustment, 30-day and 1-year mortality was significantly higher in those with more advanced renal insufficiency (Table⇓). For every 10 ml decrease in eGFR 30-day mortality increased by 3.1% (95% CI 1.00 –1.06, p=0.025), whereas 1-year mortality increased exponentially. Patients with renal insufficiency differ in presentation pattern for a MI. Although 30-day mortality increases linearly with worsening renal function, 1-year mortality differs by increasing exponentially, leading to extremely high mortality rates in those with severe renal insufficiency. Research into disease mechanisms and advances in therapies are needed to enhance outcome.