Abstract 12592: Short-term Outcomes of Acute Myocardial Infarction in Patients with Acute Kidney Injury: A Report from the National Cardiovascular Data Registry
Background: Acute kidney injury (AKI) is a risk factor for long-term adverse outcomes including myocardial infarction (MI) and death. However, the relationship between severity of AKI and in-hospital outcomes has not been well-documented.
Methods: The study population was drawn from the ACTION Registry®-GWTG™, a nation-wide sample of MI patients admitted to 383 hospitals in the United States between July 2008 and September, 2009. AKI was defined using absolute changes in serum creatinine (SCr; peak SCr - admission SCr), and categorized as no AKI (SCr change<0.3 mg/dl), mild AKI (SCr change 0.3-<0.5 mg/dl), moderate AKI (SCr change 0.5-<1.0), and severe AKI (SCr change ≥1.0 mg/dl). In-hospital mortality was compared across AKI categories in model adjusted for demographics, mortality risk factors, and baseline SCr.
Results: Overall, 59,970 patients were available for analysis; 9,659 (16.1%) had AKI, including 6.5% with mild AKI, 5.6% with moderate AKI, and 4.0% with severe AKI. Across the spectrum of AKI, patients tended to be older, had more vascular risk factors, and had higher SCr at baseline. Although patients with AKI were less likely to undergo early invasive care or receive acute antithrombotics, rates of major bleed ranged from 8.4% (no AKI) to 32.7% (severe AKI, Table). Overall, in-hospital mortality rates for those with mild, moderate and severe AKI were 6.6%, 14.2%, and 31.8% compared to 2.1% without AKI, and demonstrated similar increases in subgroups without prior CKD, in-hospital shock, or CABG. In multivariable regression, the odds ratio for in-hospital death were 2.4 (95% CI 2.0–2.7), 4.5 (95% CI 3.9–5.1), and 12.6 (95% CI 11.1–14.3) for mild, moderate, and severe AKI compared to those without AKI.
Conclusions: AKI occurs in 16% of acute MI patients. Furthermore, this common complication is strongly associated with mortality and bleeding, underscoring the importance of efforts to prevent AKI in AMI care.
- © 2010 by American Heart Association, Inc.