Abstract 322: Chronic Kidney Disease Does Not Impact Health Status Following Acute Myocardial Infarction

Abstract

Introduction: Chronic kidney disease is strongly associated with mortality after acute myocardial infarction (AMI), however, its association with health status outcomes (symptoms, function and quality of life (QoL)) is unknown. Methods: Patients with AMI were enrolled between 2003 and 2008 in the TRIUMPH registry, a national, prospective, multi-center study of health status outcomes after AMI. Detailed interviews with the disease-specific Seattle Angina Questionnaire (SAQ) and generic Short Form-12 (SF-12) were attempted on all survivors at 1, 6 and 12 months following AMI admission. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease equation and based on the highest calculated eGFR recorded during the AMI hospitalization. Patients with CKD, based on an eGFR < 60 ml/min, were compared to those without CKD. Linear repeated measures models of SAQ angina frequency and QoL and SF-12 PCS and MCS scores were used to control for treatment site, baseline health status and known covariates to assess the independent association between CKD and health status after AMI. Results: Of 3592 3,617 patients, 3,041 (84%) had no CKD and 551 576 (16%) had CKD;, 7980% stage 3 (eGFR 30-59); 1312% stage 4 (eGFR 15-29); and 8% stage 5 (eGFR <15). Patients with CKD were older (67.5 vs. 587.8) and had more co-morbidities, including heart failure, CVA, and PVD. CKD patients were more likely to have 3-vessel CAD, left ventricular dysfunction and less likely to undergo revascularization during their hospitalization. CKD patients also also had a higher 1-year mortality (8.59% vs. 2.3%; p<0.0001). Among AMI survivors at 1 -year, patients with and without CKD had similar QoL 81.9 8 vs. 81.7 (adj. difference of 0.4624, [95% CI, -1.2646, ,2.181.95]), angina frequency 91.4 vs. 93.1 (adj. difference of 1.2327, [95% CI, -0.0605, ,2.589]), and mental health scores 52.7 vs. 51.9 (adj. difference of -0.0907, [95% CI, -0.90, 2,0.7475]). Physical functioning scores were low overall at 1-year and CKD patients had slightly lower scores, 38.0 4 vs. 44.4 ((adj. difference -1.6861, [95% CI, -2.562.49, -0.749]). Conclusion: Among AMI survivorspatients who survived to 1 year, CKD patients have similar quality of life and angina burden compared to those without CKD despite a higher burden of co-morbidities. While CKD patients had lower physical functioning scores, this difference was not clinically significant compared to patients without CKD. These findings suggest that among AMI patients surviving to 1 yearsurvivors, CKD patients can achieve similar health status outcomes compared to non-CKD patients.