Abstract 12226: Combined Impact of Acute Kidney Injury and Chronic Kidney Disease on In-hospital Mortality in Patients With Acute Myocardial Infarction

Abstract

Introduction: Renal dysfunction such as acute kidney injury (AKI) as well as chronic kidney disease (CKD) is associated with poor outcomes after acute myocardial infarction (AMI). We examined the combined impact of AKI and CKD on in-hospital clinical outcomes in patients with AMI. Hypothesis: Both CKD and AKI, i.e., acute-on-chronic kidney injury, might amplify the increased risk of mortality and morbidity after AMI. Methods: J-MINUET is a prospective, multicenter registry that enrolled consecutive AMI patients who were admitted within 48 h after symptom onset between July 2012 and March 2014 at 28 hospitals in Japan. We studied serum creatinine (Cr) on admission and for the following 48 h in 2987 patients of this registry. CKD was defined as estimated glomerular filtration rate on admission <60 ml/min/1.73m2, and AKI was defined as Cr increase ≥0.3 mg/dl or ≥50% within 48 h. Results: The incidences of CKD and AKI were 41.0% and 10.5%, respectively. AKI developed more frequently in CKD patients than non-CKD patients (21.0% vs 3.1%, p<0.001). Both CKD and AKI were associated with in-hospital mortality (1.9% and 11.7% for non-CKD and CKD patients, p<0.001; 3.8% and 24.3% for non-AKI and AKI patients, p<0.001) and major adverse cardiac events (MACE) (9.3% vs 30.5% for non-CKD and CKD patients, p<0.001; 14.4% vs 49.2% for non-AKI and AKI patients, p<0.001). Multivariate analysis showed that both CKD and AKI were independent predictors of in-hospital death (CKD, odds ratio [OR] 2.02, 95%CI 1.18-3.45, p=0.010; AKI, OR 3.72, 95%CI 2.29-6.02, p<0.001) and MACE (CKD, OR 2.19, 95%CI 1.66-2.87, p<0.001; AKI, OR 2.30, 95%CI 1.62-3.25, p<0.001). When a combination of these 2 variables was analyzed, a stepwise increase in in-hospital death and MACE was observed (Figure). Conclusions: Both CKD and AKI were independent predictors of in-hospital mortality and MACE, and combined evaluation of these 2 variables enhanced the ability to predict in-hospital clinical outcomes in patients with AMI.