Abstract P183: Incident Chronic Kidney Disease and Myocardial Infarction Without Chest Pain: Results From the Atherosclerosis Risk in Communities Study

Abstract

Background: Chronic kidney disease (CKD) and cardiovascular disease share similar risk factors, such as diabetes, hypertension, and dyslipidemia promoting atherosclerosis. Acute myocardial infarction (MI) presenting without chest pain is associated with higher case fatality compared to MI with chest pain. Patients with non-ST-elevation MI (NSTEMI) are more likely to present without chest pain than patients with ST-elevation MI (STEMI). Few if any studies have examined the risk of incident CKD following MI with and without chest pain. Hypothesis: We hypothesized that MI presenting without chest pain is associated with greater risk of incident CKD after adjustment for demographic factors, in-hospital complications, and comorbidities among adults in the Atherosclerosis Risk in Communities (ARIC) Study. Methods: The ARIC Study is a community-based cohort study that began recruitment in 1987. MI without chest pain includes persons presenting with shortness of breath, nausea, or dyspnea that is determined to be of cardiac origin. Follow-up time for this analysis was calculated from date of MI hospitalization (index date) to incident CKD, death, or administrative censoring in 2017. Incident CKD was defined as eGFR <60 mL/min/1.73 m 2 and ≥25% eGFR decline from previous measurements, CKD-related hospitalization or death, or end-stage renal disease. In-hospital complications included acute heart failure, ventricular fibrillation, and cardiogenic shock. Prevalent CHD and chronic heart failure were measured at visit 1 (1987-1989) and history of diabetes and hypertension were captured from the MI hospitalization record. Results: There was a total of 1,332 MI hospitalizations with data on MI type and symptom presentation. Among 1,038 NSTEMI events, 19% presented without chest pain, compared to 7% of the 294 STEMI events presenting without chest pain. Age greater than 65 years, female gender, and hypertension at the time of the MI as well as in-hospital complications of heart failure and ventricular fibrillation were more common among NSTEMI without chest pain compared to NSTEMI with chest pain. Median follow-up time was 4.9 years (Q1, Q3: 0.9, 11.4 years). Persons with NSTEMI events presenting without chest pain had 1.82 times the risk of incident CKD (95% CI: 1.39, 2.38) compared to NSTEMI events presenting with chest pain. This association was attenuated after adjustment for age at MI, female gender, and black race (HR: 1.36, 95% CI: 1.04, 1.80) and further attenuated after additional adjustment for reperfusion within 24 hours (HR: 1.30, 95% CI: 0.99, 1.72). Conclusion: NSTEMI presenting without chest pain was associated with increased risk of incident CKD, though this association was attenuated after adjustment.