Abstract 18994: Independent and Combined Effect of Heart Failure and Renal Dysfunction on One-year Mortality in Patients with Acute Myocardial Infarction

Abstract

Background: A concept of cardio-renal syndrome has been proposed in clinical practice setting. Little is known whether there exist independent and combined effect of heart failure (HF) and renal dysfunction (RD) in patients with acute myocardial infarction (AMI) in the contemporary era.

Methods: A total of 4,700 patients with AMI who were registered to the Osaka Acute Coronary Insufficiency Study (OACIS) were studied. Patients were divided based on Killip classification (I, II, III and IV) and estimated glomerular filtration rate (eGFR) with 4 categories (CKD 1,2,3 and 4/5) on admission. One-year mortality rate and risk were compared using log-rank test and Cox regression hazard model.

Results: Ninety-one % of patients received reperfusion therapy. There was a linear relationship between both HF (3.7%, 15.2%, 32.7% and 43.0% for Killip I, II, III and IV, P<0.001) and RD (1.2%, 3.4%, 13.6% and 32.5% for CKD 1,2,3 and 4/5, P<0.001) with 1-year mortality rate, respectively. Patients with both Killip IV and CKD4/5 had highest mortality rate of 57.6% and risk with a 27-fold higher compared to those with Killip I and CKD 1 (P<0.001) (shown in figures).

Conclusions: In the contemporary reperfusion era, there exists independent and combined effect of HF and RD on 1-year mortality in patients with AMI. Explorations of novel adjunctive strategies to reduce mortality will be needed for AMI complicated with each or both HF and RD.