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Elevated serum creatinine is associated with 1-year mortality after acute myocardial infarction
Craig R Walsh1, Christopher J O'Donnell, Carlos A Camargo
1Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Insights
Elevated serum creatinine indicates higher mortality risk after acute myocardial infarction. This finding highlights the need for tailored treatments in patients with moderate renal insufficiency following a heart attack.
Area of Science:
- Cardiology
- Nephrology
- Clinical Medicine
Background:
- Cardiovascular disease is a leading cause of death in patients with end-stage renal disease.
- The prognostic impact of moderate renal insufficiency on acute myocardial infarction outcomes is not well understood.
Purpose of the Study:
- To investigate the association between elevated serum creatinine and 1-year mortality in patients with acute myocardial infarction.
- To determine if moderate renal insufficiency impacts prognosis after myocardial infarction.
Main Methods:
- A cohort of 483 patients admitted with acute myocardial infarction was studied over one year.
- Patients were stratified into groups with elevated (>133 micromol/L) or normal (< or =133 micromol/L) serum creatinine at presentation.
Main Results:
- 22% of patients presented with elevated serum creatinine.
- 1-year mortality was significantly higher in patients with elevated creatinine (46%) compared to those with normal creatinine (15%) (P <.001).
- Elevated creatinine remained an independent predictor of 1-year mortality after multivariable adjustment (adjusted hazard ratio 2.40, 95% CI 1.55-3.72).
Conclusions:
- Elevated serum creatinine at presentation is a significant risk factor for 1-year mortality in patients with acute myocardial infarction.
- The prognostic value of elevated creatinine was modified by the presence of congestive heart failure.
- Further research is warranted to optimize management strategies for this high-risk population.
Background:
Cardiovascular mortality is high in individuals with end-stage renal disease. However, less is known about the prognostic importance of moderate renal insufficiency in patients with acute myocardial infarction.
Methods:
We studied all patients with acute myocardial infarction admitted through the emergency department to an urban, academic hospital over 1 year. Patients were classified as having elevated (>133 micromol/L [1.5 mg/dL]) or normal (< or =133 micromol/L) serum creatinine at presentation.
Results:
Of 483 patients, 22% had elevated creatinine and 78% had normal creatinine. By 1 year, 46% of patients with elevated creatinine and 15% of patients with normal creatinine had died (P <.001). The unadjusted hazard ratio for 1-year mortality was increased in patients with elevated creatinine compared with those with normal creatinine (hazard ratio 3.85, 95% CI 2.61-5.67). After adjustment for baseline characteristics and treatment, the multivariable-adjusted hazard ratio for 1-year mortality remained increased in patients with elevated creatinine compared with those with normal creatinine (hazard ratio 2.40, 95% CI 1.55-3.72). There was an important modification of the prognostic value of creatinine by the presence of congestive heart failure at presentation (P value for interaction =.04). The adjusted hazard ratio for 1-year death associated with elevated creatinine compared with normal creatinine was 3.89 (95% CI 1.87-8.07) in patients without congestive heart failure and 1.92 (95% CI 1.10-3.36) in patients with congestive heart failure.
Conclusions:
Elevated serum creatinine at presentation is associated with 1-year mortality after acute myocardial infarction. Further study is needed to optimize treatment after myocardial infarction in this high-risk group.