Abstract 21186: Mild to Moderate Kidney Dysfunction is Associated with an Increased Risk of Ventricular Fibrillation in the Setting of Acute Myocardial Infarction
Background: Although end stage renal disease is known to elevate risk of sudden cardiac death (SCD), the role of less severe renal impairment in SCD is unclear. We examined this association in a case control study of patients, with no previously known structural heart disease, undergoing their first myocardial infarction (MI) with or without accompanying ventricular fibrillation (VF).
Methods and results: SCD (i.e.VF) cases (n=337, age: 56±1 yr, 80% men) were defined as patients who had a documented VF at the time of their first acute MI, and controls (n=339, age: 58±1 yr, 80% men) as those without an accompanying VF during their first acute MI. Estimated glomerular filtration rate (eGFR) at the time of the acute MI was computed using the 4-variable Modification of Diet in Renal Disease equation. Restricted cubic spline model revealed a non-linear dose-response association between eGFR and occurrence of a fatal VF at the time of MI. At eGFR less than 105 ml/min, decrease in eGFR was associated with elevated odds of developing VF at the time of MI. The association was essentially flat at eGFR levels greater than 105ml/min (figure). The prevalence of VF (34%, 32%, 48%, 60%, and 75% respectively) increased with eGFR quintiles representing worsening kidney function. The lowest eGFR quintile was associated with over a 5-fold increase in odds of developing VF compared to the fourth quintile. This association between eGFR and VF at the time of MI remained significant after adjusting for potential confounders including electrolyte levels.
Conclusion: Mild to moderate kidney dysfunction is associated with a significantly elevated risk of fatal arrhythmias in the setting of acute MI. Further studies should investigate the precise mechanisms by which mild kidney function results in VF (SCD).
- © 2010 by American Heart Association, Inc.