Chronic kidney disease and long-term outcomes of myocardial infarction.

Abstract Background Although chronic kidney disease (CKD) is a risk factor for cardiovascular disease, information about myocardial infarction (MI) with CKD is limited in the acute revascularization era. Methods To clarify the relationship between CKD and long-term outcomes of MI, consecutive 4550 patients with acute MI treated at 17 participating hospitals were analyzed. The primary study outcome was death from any cause, and a secondary endpoint was the first appearance major adverse cardiovascular events. Results Acute revascularization therapies were performed in 75.2% of the patients and the mean left ventricular ejection fraction (LVEF) was 53%. The median follow-up was 4.1years (follow-up rate, 95.2%). Patients were divided into four categories ( 2 of body-surface area) according to the glomerular filtration rate (GFR) estimated by the Modification of Diet in Renal Disease equation. A total of 1941 (42.7%) patients had an estimated GFR of 2 . Mortality rates increased with declining estimated GFR. Unadjusted hazard ratios for total and cardiovascular death in the group with an estimated GFR of 45.0 to 59.9mL/min per 1.73m 2 using the group with an estimated GFR of ≥75.0mL/min per 1.73m 2 as the reference were 1.63 (95% CI, 1.28 to 2.07) and 2.09 (95% CI, 1.45 to 3.01), respectively. Conclusions Even early-stage CKD should be considered a powerful risk factor for long-term cardiovascular death after acute MI with preserved LVEF in the acute revascularization era.