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Impact of Acute and Chronic Kidney Disease on Heart Failure Hospitalizations After Acute Myocardial Infarction

Srikanth Yandrapalli1, John Christy2, Aaqib Malik3

  • 1Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.

The American Journal of Cardiology
|December 11, 2021
PubMed

Insights

Acute kidney injury (AKI) and chronic kidney disease (CKD) significantly increase heart failure (HF) hospitalization risk after acute myocardial infarction (AMI). Patients with renal failure, especially AKI on CKD, face the highest risk of HF readmission and mortality.

Area of Science:

  • Cardiology
  • Nephrology
  • Public Health

Background:

  • Acute myocardial infarction (AMI) survivors face significant risks of subsequent heart failure (HF) hospitalizations.
  • The impact of co-existing renal conditions, including acute kidney injury (AKI) and chronic kidney disease (CKD), on post-AMI HF risk is not well-established.
  • Understanding these risks is crucial for managing AMI survivors with renal impairment.

Purpose of the Study:

  • To evaluate the association between various forms of renal impairment and the risk of heart failure hospitalization following an acute myocardial infarction.
  • To compare the HF hospitalization risk across different categories of renal function in AMI survivors.

Main Methods:

  • Retrospective cohort analysis of adult AMI survivors from the US Nationwide Readmissions Database (January-June 2014).
  • Patients categorized into: no renal injury, AKI without CKD, stable CKD, AKI on CKD, and end-stage renal disease (ESRD).
  • Outcomes assessed included 6-month HF hospitalization, fatal HF, and composite outcomes using multivariable logistic regression.

Main Results:

  • Of 237,549 AMI survivors, 13.8% had AKI, 16.5% had CKD, 3.4% had ESRD, and 7.7% had AKI on CKD.
  • Patients with any renal failure showed lower coronary revascularization rates and higher in-hospital HF.
  • Compared to those without renal failure (3.3%), 6-month HF hospitalization rates were significantly higher for AKI on CKD (14.6%), ESRD (11.2%), stable CKD (10.7%), and AKI (8.6%).

Conclusions:

  • Approximately one in four AMI survivors present with acute or chronic renal failure.
  • Any form of renal failure substantially increases the risk of 6-month HF hospitalizations and associated mortality post-AMI.
  • The highest risk for HF hospitalization was observed in patients with acute kidney injury superimposed on chronic kidney disease (AKI on CKD).

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