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Renal failure and acute myocardial infarction: clinical characteristics in patients with advanced chronic kidney disease, on dialysis, and without chronic kidney disease. A collaborative project of the United States Renal Data System/National Institutes o

Abstract：

BACKGROUND:Patients with chronic kidney disease (CKD) experience poor outcomes after acute myocardial infarction (AMI). We sought to compare clinical characteristics of advanced CKD, dialysis, and non-CKD patients hospitalized with AMI. METHODS:This observational study used record-linked data from the US Renal Data System and Third National Registry of Myocardial Infarction to identify 2,390 dialysis patients with AMI hospitalizations between April 1998 and June 2000. Advanced CKD patients (n = 29,319) were identified by baseline creatinine level ≥2.5 mg/dL. Clinical characteristics of CKD, dialysis, and non-CKD patients (n = 274,777) were compared using the χ(2) test. RESULTS:Clinically significant differences among patients with advanced CKD (dialysis and non-CKD, respectively) on admission were chest pain, 40.4% (41.1% and 61.6%); diagnosis other than acute coronary syndrome, 44% (47.7% and 25.8%); and ST elevation, 15.9% (17.6% and 32.5%). In-hospital adverse outcomes were mortality, 23% (21.7% and 12.6%); unexpected cardiac arrest, 8.9% (12.3% and 6%); congestive heart failure, 41% (25.8% and 21.1%); and major bleeding, 4.9% (4.4% and 3%); P < .001 for all comparisons. In a logistic regression model, the adjusted odds ratio for in-hospital mortality for CKD (vs non-CKD) patients was 1.44 (95% CI 1.39-1.49). CONCLUSIONS:The clinical characteristics of non-dialysis-dependent, advanced CKD patients with AMI are similar to characteristics of dialysis patients and likely contribute to poor outcomes. Intensive efforts for timely, accurate recognition of AMI in advanced CKD patients are warranted.

journal_name

Am Heart J

journal_title

American heart journal

authors

Shroff GR,Frederick PD,Herzog CA

doi

10.1016/j.ahj.2011.12.002

subject

Has Abstract

pub_date

2012-03-01 00:00:00

pages

399-406

issue

3

eissn

0002-8703

issn

1097-6744

pii

S0002-8703(11)00883-0

journal_volume

163

pub_type

杂志文章,多中心研究

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