Abstract 14230: Decreased Estimated Glomerular Filtration Rate Deteriorates Long-term Prognosis After St-segment Elevation Acute Myocardial Infarction
The impact of chronic kidney disease (CKD) on long-term prognosis for acute myocardial infarction remains to be determined. We investigated impact of CKD stage on early mortality and long-term outcome in patients with ST-segment elevation acute myocardial infarction (STEMI). This study evaluated 176 patients with STEMI between 2005 and 2008, mean age of 68 ± 12 years, 131 male (median follow-up period of 527 days). There were 55 patients with CKD (31%, estimated glomerular filtration rate < 60 ml/min/1.73m2). Patients with CKD were older (74 ± 10 vs. 66 ± 13 years, P < 0.0001), and more likely to show signs of heart failure on presentation (Killip class ≥ 2, 36% vs. 17%, P = 0.0036) and did not undergo percutaneous coronary intervention (PCI) and/or coronary artery bypass graft (20 vs. 6%, P = 0.0039) compared to patients without CKD. We observed higher levels of brain natriuretic peptide (BNP) and lower left ventricular ejection fraction in patients with CKD compared to those without CKD. Kaplan-Meier analysis revealed that the mortality increased with advancing CKD stage (Log-rank test, P < 0.0001). Multivariate analysis revealed that CKD and heart failure were independent predictors of the early mortality. Because greater part of cardiac death was in-hospital death (94%), we also evaluated major adverse cardiac events (MACE) such as death, rehospitalization for heart failure, and myocardial infarction among 161 patients surviving to hospital dischage (median follow-up period of 534 days). The patients with CKD had more MACE compared to those without CKD (Log-rank test, P = 0.0008). Multivariate Cox proportional hazards models revealed that CKD was an independent predictor of MACE in STEMI patients. The log BNP and plasma heart fatty acid-binding protein levels at both discharge and chronic stage were increased with advancing CKD stage. In conclusion, CKD is an independent predictor of early mortality and long-term adverse cardiac events in patients following STEMI.
- © 2010 by American Heart Association, Inc.