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Interaction between anemia and renal dysfunction in relation to long-term survival following acute myocardial
Alon Shechter1,2,3, Arthur Shiyovich4,5,6, Keren Skalsky4,5
1Department of Cardiology, Cedars-Sinai Medical Center, Smidt Heart Institute, 127 S San Vicente Blvd A3100, Los Angeles, CA, 90048, USA. alonshechter@gmail.com.
Insights
Anemia and chronic kidney disease (CKD) independently increase mortality risk after acute myocardial infarction (AMI). Their combined presence, especially in lower-grade CKD, significantly reduces long-term survival post-AMI.
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Anemia and chronic kidney disease (CKD) are known to worsen outcomes after acute myocardial infarction (AMI).
- The interaction between anemia and CKD in long-term survival post-AMI requires further investigation.
Purpose of the Study:
- To assess the combined impact of anemia and CKD on 10-year all-cause mortality in patients following AMI.
- To understand the independent and interactive effects of anemia and CKD severity on long-term survival after AMI.
Main Methods:
- Retrospective analysis of 11,395 AMI survivors from a single center.
- Patients were stratified by anemia status and CKD grade (based on hemoglobin and creatinine).
- All-cause mortality was evaluated over a 10-year follow-up period.
Main Results:
- Anemia (29.9%) and advanced CKD (15.9%) were prevalent. Anemia increased with CKD grade (p<0.001).
- Anemia (HR 1.40) and higher CKD grade (HR 1.10) were independently associated with increased 10-year mortality.
- The combined risk was most pronounced in patients with lower-grade CKD.
Conclusions:
- Anemia and advanced CKD significantly reduce long-term survival after AMI.
- The combination of anemia and CKD poses a higher mortality risk, particularly when CKD is less advanced.
- These findings highlight the importance of managing both conditions in AMI patients.
Background:
Anemia and chronic kidney disease (CKD) adversely affect prognosis following acute myocardial infarction (AMI). We aimed to assess their interaction regarding long-term survival post-AMI.
Methods:
This is a single-center, retrospective analysis of consecutive AMI survivors. Stratified by admission-time anemia status and CKD grade, as determined by hemoglobin and creatinine levels, the cohort was evaluated for all-cause mortality at 10 years after hospital discharge.
Results:
A total of 11,395 patients (69.1% males, mean age 65.8 ± 13.9 years, 49.6% with ST elevation MI) were included, of whom 29.9% had anemia and 15.9% - grade 3b or higher CKD. CKD was more advanced among anemic patients and the prevalence of anemia rose as CKD grade increased (p for trend < 0.001). At 10 years, 47.8% of patients died. Notwithstanding differences in baseline characteristics, presentation, and treatment between those with various anemia status and CKD grades, anemia presence (HR 1.40, 95% CI 1.32-1.49, p < 0.001) and increasing CKD grade (HR 1.10, 95% CI 1.02-1.20, p for trend < 0.001) were independently associated with a higher mortality risk. The incremental hazard imposed by either anemia or more advanced CKD was limited to patients with normal renal function and up to grade 3a (in the total cohort and the conservative treatment subgroup) or 4 (in the invasive revascularization subgroup) CKD. The added risk associated with increasing CKD grade also affected non-anemic individuals irrespective of the specific CKD grade.
Conclusion:
Anemia and more advanced CKD are associated with reduced long-term survival post-AMI, inflicting higher risk when conjoined in lower-grade CKD.
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