Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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The Impact of Moderate to Severe Renal Insufficiency on Patients With Acute Myocardial Infarction

  • Son, Ji-Hyun (Department of Internal Medicine, College of Medicine, Keimyung University) ;
  • Hur, Seung-Ho (Department of Internal Medicine, College of Medicine, Keimyung University) ;
  • Kim, In-Cheol (Department of Internal Medicine, College of Medicine, Keimyung University) ;
  • Cho, Yun-Kyeong (Department of Internal Medicine, College of Medicine, Keimyung University) ;
  • Park, Hyoung-Seob (Department of Internal Medicine, College of Medicine, Keimyung University) ;
  • Yoon, Hyuck-Jun (Department of Internal Medicine, College of Medicine, Keimyung University) ;
  • Kim, Hyung-Seop (Department of Internal Medicine, College of Medicine, Keimyung University) ;
  • Nam, Chang-Wook (Department of Internal Medicine, College of Medicine, Keimyung University) ;
  • Kim, Yoon-Nyun (Department of Internal Medicine, College of Medicine, Keimyung University) ;
  • Kim, Kwon-Bae (Department of Internal Medicine, College of Medicine, Keimyung University)
  • Published : 2011.06.30
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Abstract

Background and Objectives: Renal insufficiency (RI) has been reported to be associated with unfavorable clinical outcomes in patients undergoing percutaneous coronary interventions (PCI). However, little data is available regarding the impact of moderate to severe RI on clinical outcomes in patients with acute myocardial infarction (AMI) undergoing PCI. Subjects and Methods: Between March 2003 and July 2007, 878 patients with AMI who underwent PCI were enrolled. Based on estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) equation, patients were divided into two groups: eGFR <60 $mL/min{\cdot}m^{2}$ (moderate to severe RI, group A) and eGFR ${\geq}$60 $mL/min{\cdot}m^{2}$ (normal to mild RI, group B). The primary endpoint was all-cause mortality at 1-year after successful PCI. The secondary endpoints were non-fatal myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), stent thrombosis (ST) and major adverse cardiac events (MACE) at 1-year. Results: In group A, patients were more often male and older, with diabetes and hypertension. Compared to patients in group B, group A showed significantly higher incidences of all-cause mortality, cardiac mortality, non-fatal MI and MACE. The needs of TLR and TVR, and the incidence of ST were not significantly different between the two groups. Independent predictors of 1-year mortality were eGFR <60 $mL/min{\cdot}m^{2}$, male gender, older age and a lower left ventricular ejection fraction. Conclusion: In patients with AMI, moderate to severe RI was associated with mortality and MACE at 1-year after successful PCI. In addition, eGFR <60 $mL/min{\cdot}m^{2}$ was a strong independent predictor of 1-year mortality.

Keywords

References

  1. Best PJ, Lennon R, Ting HH, et al. The impact of renal insufficiency on clinical outcomes in patients undergoing percutaneous coronary interventions. J Am Coll Cardiol 2002;39:1113-9. https://doi.org/10.1016/S0735-1097(02)01745-X
  2. Singh M, Rihal CS, Selzer F, Kip KE, Detre K, Holmes DR. Validation of Mayo Clinic risk adjustment model for in-hospital complications after percutaneous coronary interventions, using the National Heart, Lung, and Blood Institute dynamic registry. J Am Coll Cardiol 2003;42:1722-8. https://doi.org/10.1016/j.jacc.2003.05.007
  3. Feldman DN, Gade CL, Slotwiner AJ, et al. Comparison of outcomes of percutaneous coronary interventions in patients of three age gr-oups (<60, 60 to 80, and >80 years) (from the New York State Angioplas-ty Registry). Am J Cardiol 2006;98:1334-9. https://doi.org/10.1016/j.amjcard.2006.06.026
  4. Gruberg L, Dangas G, Mehran R, et al. Clinical outcome following per-cutaneous coronary interventions in patients with chronic renal failure. Catheter Cardiovasc Interv 2002;55:66-72. https://doi.org/10.1002/ccd.10103
  5. Klein LW, Block P, Brindis RG, et al. Percutaneous coronary interven-tions in octogenarians in the American College of Cardiology-Nation-al Cardiovascular Data Registry: development of a nomogram predic-tive of in-hospital mortality. J Am Coll Cardiol 2002;40:394-402. https://doi.org/10.1016/S0735-1097(02)01992-7
  6. Beattie JN, Soman SS, Sandberg KR, et al. Determinants of mortality after myocardial infarction in patients with advanced renal dysfunction. Am J Kidney Dis 2001;37:1191-200. https://doi.org/10.1053/ajkd.2001.24522
  7. Zhang RY, Zhu ZB, Zhang Q, et al. Impact of moderate or severe renal insufficiency on long-term outcomes in patients undergoing drug-elut-ing stent based coronary intervention. Int J Cardiol 2009;136:72-9. https://doi.org/10.1016/j.ijcard.2008.04.028
  8. Yamaguchi J, Kasanuki H, Ishii Y, et al. Prognostic significance of se-rum creatinine concentration for in-hospital mortality in patients with acute myocardial infarction who underwent successful primary percutaneous coronary intervention (from the Heart Institute of Japan Acute Myocardial Infarction [HIJAMI] Registry). Am J Cardiol 2004;93: 1526-8. https://doi.org/10.1016/j.amjcard.2004.02.065
  9. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39(2 Suppl 1):S1-266.
  10. Shlipak MG, Heidenreich PA, Noguchi H, Chertow GM, Browner WS, McClellan MB. Association of renal insufficiency with treatment and outcomes after myocardial infarction in elderly patients. Ann Intern Med 2002;137:555-62. https://doi.org/10.7326/0003-4819-137-7-200210010-00006
  11. Cutlip DE, Windecker S, Mehran R, et al. Clinical end points in coron-ary stent trials: a case for standardized definitions. Circulation 2007; 115:2344-51. https://doi.org/10.1161/CIRCULATIONAHA.106.685313
  12. Hsu CY, Iribarren C, McCulloch CE, Darbinian J, Go AS. Risk factors for end-stage renal disease: 25-year follow-up. Arch Intern Med 2009;169:342-50. https://doi.org/10.1001/archinternmed.2008.605
  13. Plantinga LC, Boulware LE, Coresh J, et al. Patient awareness of chronic kidney disease: trends and predictors. Arch Intern Med 2008;168:2268-75. https://doi.org/10.1001/archinte.168.20.2268
  14. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum cr-eatinine: a new prediction equation. Modification of Diet in Renal Dise-ase Study Group. Ann Intern Med 1999;130:461-70. https://doi.org/10.7326/0003-4819-130-6-199903160-00002
  15. Kanani PM, Sinkey CA, Browning RL, Allaman M, Knapp HR, Hay-nes WG. Role of oxidant stress in endothelial dysfunction produced by experimental hyperhomocyst(e)inemia in humans. Circulation 1999; 100:1161-8. https://doi.org/10.1161/01.CIR.100.11.1161
  16. Massy ZA, Kasiske BL. Hyperlipidemia and its management in renal disease. Curr Opin Nephrol Hypertens 1996;5:141-6. https://doi.org/10.1097/00041552-199603000-00007
  17. Romanic AM, Arleth AJ, Willette RN, Ohlstein EH. Factor XIIIa cr-oss-links lipoprotein(a) with fibrinogen and is present in human atherosclerotic lesions. Circ Res 1998;83:264-9. https://doi.org/10.1161/01.RES.83.3.264
  18. Busch M, Franke S, Muller A, et al. Potential cardiovascular risk fac-tors in chronic kidney disease: AGEs, total homocysteine and metabolites, and the C-reactive protein. Kidney Int 2004;66:338-47. https://doi.org/10.1111/j.1523-1755.2004.00736.x
  19. Bjorkbacka H, Kunjathoor VV, Moore KJ, et al. Reduced atherosclerosis in MyD88-null mice links elevated serum cholesterol levels to activation of innate immunity signaling pathways. Nat Med 2004;10: 416-21. https://doi.org/10.1038/nm1008
  20. Cheung AK, Sarnak MJ, Yan G, et al. Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients. Kidney Int 2000;58: 353-62. https://doi.org/10.1046/j.1523-1755.2000.00173.x
  21. Choi JH, Kim KL, Huh W, et al. Decreased number and impaired an-giogenic function of endothelial progenitor cells in patients with ch-ronic renal failure. Arterioscler Thromb Vasc Biol 2004;24:1246-52. https://doi.org/10.1161/01.ATV.0000133488.56221.4a
  22. Herzog CA, Ma JZ, Collins AJ. Poor long-term survival after acute myocardial infarction among patients on long-term dialysis. N Engl J Med 1998;339:799-805. https://doi.org/10.1056/NEJM199809173391203
  23. Chertow GM, Normand SL, Silva LR, McNeil BJ. Survival after acu-te myocardial infarction in patients with end-stage renal disease: results from the cooperative cardiovascular project. Am J Kidney Dis 2000;35:1044-51. https://doi.org/10.1016/S0272-6386(00)70038-2
  24. Wright RS, Reeder GS, Herzog CA, et al. Acute myocardial infarction and renal dysfunction: a high-risk combination. Ann Intern Med 2002;137:563-70. https://doi.org/10.7326/0003-4819-137-7-200210010-00007