Renal function and mortality up to 20 years after myocardial infarction: temporal trends over the last three decades

Purpose: To examine temporal trends in treatment and mortality after myocardial infarction (MI) depending on renal function at presentation. Methods: We studied 12087 patients admitted for MI to a coronary care unit from 1985 to 2008. In line with the Kidney Foundation practice guidelines patients were categorized into normal renal function (eGFR >90 ml/min), mild (60-89), moderate (30-59), and severe renal impairment (<30). A total of 8648 (72%) of the 12087 patients had mild to severe renal impairment. Results: Use of evidence-based care increased over time in all four groups according to renal function. Mortality rates fell over the period. Adjusted 30-day mortality fell (adjusted odds [2000-2008 vs. 1985-1990] 0.30 [95% CI 0.16-0.58] in patients with severe renal impairment, and 0.18 [95% CI 0.09-0.37] in those without renal impairment). Adjusted 10-year mortality improved similarly. There was no significant interaction between renal function and decade of admission. Overall, median survival was 20, 16, 8 and 1.6 years for patients with normal renal function, mild, moderate and severe renal impairment, respectively. ![Figure][1] Conclusions: During the past 25 years, treatment of patients with an MI improved substantially with a concomitant decline in both short- and long-term mortality that was similar for all stages of renal function, however, prognosis remains poor after severe renal impairment. [1]: pending:yes