Renal Dysfunction was an Independent Predictor of In-Hospital Death and Ventricular Rupture in Patients With Acute
Masayuki Goto1, Eiji Oda2, Hirooki Matsushita1
1Cardiovascular Center, Tachikawa Medical Center, Nagaoka, Japan.
Insights
Renal dysfunction (RD) predicts in-hospital death (In-HD) and ventricular rupture (VR) in acute myocardial infarction (AMI) patients. Identifying these predictors aids in managing AMI and improving patient outcomes.
Area of Science:
- Cardiology
- Nephrology
- Critical Care Medicine
Background:
- Predictors of in-hospital death (In-HD) in acute myocardial infarction (AMI) patients are crucial for risk stratification.
- Existing research suggests various factors influence outcomes beyond disease severity.
Purpose of the Study:
- To investigate independent predictors of In-HD and ventricular rupture (VR) in patients experiencing their first AMI.
- To identify specific patient characteristics and comorbidities associated with increased mortality and mechanical complications.
Main Methods:
- Stepwise multivariable logistic regression analysis was employed.
- The study included 1,042 patients admitted within 48 hours of AMI symptom onset.
- Data on demographics, clinical factors, and outcomes were collected and analyzed.
Main Results:
- Renal dysfunction (RD), defined as estimated glomerular filtration rate < 60 mL/min/1.73 m², was a significant independent positive predictor of In-HD.
- Age and RD were independent predictors of VR, while diabetes also emerged as a predictor for VR.
- Hypercholesterolemia was found to be an independent negative predictor for In-HD.
Conclusions:
- Renal dysfunction (RD) is a critical independent predictor of both in-hospital death (In-HD) and ventricular rupture (VR) in the setting of initial acute myocardial infarction (AMI).
- These findings highlight the importance of assessing renal function in AMI patients for prognostication and management.
Background:
Apart from the severity of myocardial infarction and coronary artery disease, several predictors of in-hospital death (In-HD) are suggested in patients with acute myocardial infarction (AMI).
Methods:
We investigated predictors of In-HD and ventricular rupture (VR) including ventricular septal rupture (VSR) and free wall rupture (FWR) with stepwise multivariable logistic regressions in 1,042 patients admitted to our Cardiovascular Center within 48 hours from symptom onset for the first attack of AMI.
Results:
In-HD, VSR, and FWR were observed in 78 cases (7.5%), 14 cases of which 13 cases were In-HD, and 13 cases of which 6 cases were In-HD, respectively. Apart from the disease severity, age and renal dysfunction (RD) defined by estimated glomerular filtration rate of lower than 60 mL/min/ 1.73 m2 were independent positive predictors of In-HD (the odds ratios (ORs) (95% confidence interval (CI)): 1.04 (1.01 - 1.06) P = 0.0069 and 5.75 (3.12 - 10.59) P < 0.0001, respectively) and hypercholesterolemia was an independent negative predictor for In-HD (OR (95% CI): 0.34 (0.17 - 0.67) P = 0.0017). After including the categories of coronary disease, ventricular rupture, and ejection fraction in predictors, RD remained an independent predictor of In-HD (OR (95% CI): 6.65 (2.67 - 16.60) P < 0.0001). Age (OR (95% CI): 1.07 (1.02 - 1.12) P = 0.0064), RD (OR (95% CI): 2.77 (1.18 - 6.49) P = 0.019), and diabetes (OR (95% CI): 2.52 (1.12 - 5.71) P = 0.026) were independent predictors of VR.
Conclusions:
RD was an independent predictor of In-HD and VR in patients with initial AMI.
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