GFR and cardiovascular outcomes after acute myocardial infarction

Results from the Korea acute myocardial infarction registry

Eun Hui Bae, Sang Yeob Lim, Kyung Hoon Cho, Joon Seok Choi, Chang Seong Kim, Jeong Woo Park, Seong Kwon Ma, Myung Ho Jeong, Soo Wan Kim

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

Background: Despite strong evidence linking decreased glomerular filtration rate (GFR) to worse outcomes, the impact of GFR on mortality and morbidity in patients with acute myocardial infarction (AMI) is not well defined. Study Design: Retrospective cohort study. Setting & Participants: 12,636 patients with AMI in the Korea AMI Registry database from November 2005 to July 2008. 93% of patients in this registry had coronary angiography, and 91% of patients with coronary angiography had percutaneous coronary intervention (PCI). Predictor: GFR was estimated (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, and patients were grouped into 5 eGFR categories: >90, 60-89, 30-59, 15-29, and <15 mL/min/1.73 m 2. Outcomes: Primary end points were death and in-hospital complications. Secondary end points were major adverse cardiac events (MACEs) during a 1-month (short-term) and 1-year (long-term) follow-up after AMI. Results: Mean eGFR was 72.8 ± 24.6 mL/min/1.73 m 2, mean age was 64 ± 13 years, and 70.4% were men. A graded association was observed between eGFR and clinical outcomes. In adjusted analyses, compared with eGFR >90 mL/min/1.73 m 2, patients with eGFR of 30-59, 15-29, and <15 mL/min/1.73 m 2 experienced increased risks of short- (respective HRs of 2.30 [95% CI, 1.70-3.11], 3.10 [95% CI, 2.14-4.14], and 3.64 [95% CI, 2.44-5.43]; P < 0.001) and long-term MACEs (HRs of 1.58 [95% CI, 1.32-1.90], 2.12 [95% CI, 1.63-2.75], and 2.50 [95% CI, 1.89-3.29]; P < 0.001). Older age, Killip class higher than I, PCI, and high-sensitivity C-reactive protein level also were associated with higher short- and long-term MACEs. Use of β-blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), and statins was associated with decreased risk of MACEs. Limitations: Single assessment of serum creatinine. Conclusion: eGFR was associated independently with mortality and complications after AMI. PCI, β-blocker, ACE inhibitor or ARB, and statin use were associated with decreased risks of short- and long-term MACEs.

Original languageEnglish
Pages (from-to)795-802
Number of pages8
JournalAmerican Journal of Kidney Diseases
Volume59
Issue number6
DOIs
Publication statusPublished - 2012 Jun 1

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Korea
Glomerular Filtration Rate
Registries
Myocardial Infarction
Percutaneous Coronary Intervention
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Angiotensin Receptor Antagonists
Coronary Angiography
Angiotensin-Converting Enzyme Inhibitors
Mortality
Chronic Renal Insufficiency
C-Reactive Protein
Creatinine
Epidemiology
Cohort Studies
Retrospective Studies
Databases
Morbidity
Serum

Keywords

  • Acute myocardial infarction
  • glomerular filtration rate
  • major adverse cardiac event

ASJC Scopus subject areas

  • Nephrology

Cite this

GFR and cardiovascular outcomes after acute myocardial infarction : Results from the Korea acute myocardial infarction registry. / Bae, Eun Hui; Lim, Sang Yeob; Cho, Kyung Hoon; Choi, Joon Seok; Kim, Chang Seong; Park, Jeong Woo; Ma, Seong Kwon; Jeong, Myung Ho; Kim, Soo Wan.

In: American Journal of Kidney Diseases, Vol. 59, No. 6, 01.06.2012, p. 795-802.

Research output: Contribution to journalArticle

Bae, Eun Hui ; Lim, Sang Yeob ; Cho, Kyung Hoon ; Choi, Joon Seok ; Kim, Chang Seong ; Park, Jeong Woo ; Ma, Seong Kwon ; Jeong, Myung Ho ; Kim, Soo Wan. / GFR and cardiovascular outcomes after acute myocardial infarction : Results from the Korea acute myocardial infarction registry. In: American Journal of Kidney Diseases. 2012 ; Vol. 59, No. 6. pp. 795-802.
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abstract = "Background: Despite strong evidence linking decreased glomerular filtration rate (GFR) to worse outcomes, the impact of GFR on mortality and morbidity in patients with acute myocardial infarction (AMI) is not well defined. Study Design: Retrospective cohort study. Setting & Participants: 12,636 patients with AMI in the Korea AMI Registry database from November 2005 to July 2008. 93{\%} of patients in this registry had coronary angiography, and 91{\%} of patients with coronary angiography had percutaneous coronary intervention (PCI). Predictor: GFR was estimated (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, and patients were grouped into 5 eGFR categories: >90, 60-89, 30-59, 15-29, and <15 mL/min/1.73 m 2. Outcomes: Primary end points were death and in-hospital complications. Secondary end points were major adverse cardiac events (MACEs) during a 1-month (short-term) and 1-year (long-term) follow-up after AMI. Results: Mean eGFR was 72.8 ± 24.6 mL/min/1.73 m 2, mean age was 64 ± 13 years, and 70.4{\%} were men. A graded association was observed between eGFR and clinical outcomes. In adjusted analyses, compared with eGFR >90 mL/min/1.73 m 2, patients with eGFR of 30-59, 15-29, and <15 mL/min/1.73 m 2 experienced increased risks of short- (respective HRs of 2.30 [95{\%} CI, 1.70-3.11], 3.10 [95{\%} CI, 2.14-4.14], and 3.64 [95{\%} CI, 2.44-5.43]; P < 0.001) and long-term MACEs (HRs of 1.58 [95{\%} CI, 1.32-1.90], 2.12 [95{\%} CI, 1.63-2.75], and 2.50 [95{\%} CI, 1.89-3.29]; P < 0.001). Older age, Killip class higher than I, PCI, and high-sensitivity C-reactive protein level also were associated with higher short- and long-term MACEs. Use of β-blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), and statins was associated with decreased risk of MACEs. Limitations: Single assessment of serum creatinine. Conclusion: eGFR was associated independently with mortality and complications after AMI. PCI, β-blocker, ACE inhibitor or ARB, and statin use were associated with decreased risks of short- and long-term MACEs.",
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T1 - GFR and cardiovascular outcomes after acute myocardial infarction

T2 - Results from the Korea acute myocardial infarction registry

AU - Bae, Eun Hui

AU - Lim, Sang Yeob

AU - Cho, Kyung Hoon

AU - Choi, Joon Seok

AU - Kim, Chang Seong

AU - Park, Jeong Woo

AU - Ma, Seong Kwon

AU - Jeong, Myung Ho

AU - Kim, Soo Wan

PY - 2012/6/1

Y1 - 2012/6/1

N2 - Background: Despite strong evidence linking decreased glomerular filtration rate (GFR) to worse outcomes, the impact of GFR on mortality and morbidity in patients with acute myocardial infarction (AMI) is not well defined. Study Design: Retrospective cohort study. Setting & Participants: 12,636 patients with AMI in the Korea AMI Registry database from November 2005 to July 2008. 93% of patients in this registry had coronary angiography, and 91% of patients with coronary angiography had percutaneous coronary intervention (PCI). Predictor: GFR was estimated (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, and patients were grouped into 5 eGFR categories: >90, 60-89, 30-59, 15-29, and <15 mL/min/1.73 m 2. Outcomes: Primary end points were death and in-hospital complications. Secondary end points were major adverse cardiac events (MACEs) during a 1-month (short-term) and 1-year (long-term) follow-up after AMI. Results: Mean eGFR was 72.8 ± 24.6 mL/min/1.73 m 2, mean age was 64 ± 13 years, and 70.4% were men. A graded association was observed between eGFR and clinical outcomes. In adjusted analyses, compared with eGFR >90 mL/min/1.73 m 2, patients with eGFR of 30-59, 15-29, and <15 mL/min/1.73 m 2 experienced increased risks of short- (respective HRs of 2.30 [95% CI, 1.70-3.11], 3.10 [95% CI, 2.14-4.14], and 3.64 [95% CI, 2.44-5.43]; P < 0.001) and long-term MACEs (HRs of 1.58 [95% CI, 1.32-1.90], 2.12 [95% CI, 1.63-2.75], and 2.50 [95% CI, 1.89-3.29]; P < 0.001). Older age, Killip class higher than I, PCI, and high-sensitivity C-reactive protein level also were associated with higher short- and long-term MACEs. Use of β-blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), and statins was associated with decreased risk of MACEs. Limitations: Single assessment of serum creatinine. Conclusion: eGFR was associated independently with mortality and complications after AMI. PCI, β-blocker, ACE inhibitor or ARB, and statin use were associated with decreased risks of short- and long-term MACEs.

AB - Background: Despite strong evidence linking decreased glomerular filtration rate (GFR) to worse outcomes, the impact of GFR on mortality and morbidity in patients with acute myocardial infarction (AMI) is not well defined. Study Design: Retrospective cohort study. Setting & Participants: 12,636 patients with AMI in the Korea AMI Registry database from November 2005 to July 2008. 93% of patients in this registry had coronary angiography, and 91% of patients with coronary angiography had percutaneous coronary intervention (PCI). Predictor: GFR was estimated (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, and patients were grouped into 5 eGFR categories: >90, 60-89, 30-59, 15-29, and <15 mL/min/1.73 m 2. Outcomes: Primary end points were death and in-hospital complications. Secondary end points were major adverse cardiac events (MACEs) during a 1-month (short-term) and 1-year (long-term) follow-up after AMI. Results: Mean eGFR was 72.8 ± 24.6 mL/min/1.73 m 2, mean age was 64 ± 13 years, and 70.4% were men. A graded association was observed between eGFR and clinical outcomes. In adjusted analyses, compared with eGFR >90 mL/min/1.73 m 2, patients with eGFR of 30-59, 15-29, and <15 mL/min/1.73 m 2 experienced increased risks of short- (respective HRs of 2.30 [95% CI, 1.70-3.11], 3.10 [95% CI, 2.14-4.14], and 3.64 [95% CI, 2.44-5.43]; P < 0.001) and long-term MACEs (HRs of 1.58 [95% CI, 1.32-1.90], 2.12 [95% CI, 1.63-2.75], and 2.50 [95% CI, 1.89-3.29]; P < 0.001). Older age, Killip class higher than I, PCI, and high-sensitivity C-reactive protein level also were associated with higher short- and long-term MACEs. Use of β-blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), and statins was associated with decreased risk of MACEs. Limitations: Single assessment of serum creatinine. Conclusion: eGFR was associated independently with mortality and complications after AMI. PCI, β-blocker, ACE inhibitor or ARB, and statin use were associated with decreased risks of short- and long-term MACEs.

KW - Acute myocardial infarction

KW - glomerular filtration rate

KW - major adverse cardiac event

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