Impact of chronic kidney disease staging by estimated glomerular filtration rate on clinical outcome of acute myocardial infarction

Abstract

Abstract Background Although chronic kidney disease (CKD) has been known to have poor clinical outcome in patients with acute myocardial infarction (AMI), CKD staging by estimated glomerular filtration rate (eGFR) is not widely utilized in daily practice. Purpose This study was aimed to assess the impact of CKD staging by eGFR on clinical outcome in patients with AMI. Methods We analyzed the Japanese observational prospective multi-center registry of AMI which included a total of 10870 patients between October 2016 and December 2021. Based on eGFR, patients were divided into stage 1(≧90), 2 (60-89), 3a (45-59), 3b (30-44), 4 (15-29) and 5 (<15) and clinical outcomes were followed for 30 days. A major adverse cardiac event (MACE) was defined as cardiovascular death, non-fatal myocardial infarction (MI) and non-fatal stroke. Bleeding Academic Research Consortium (BARC) type 3 or 5 was used to assess bleeding events. Composite events included both MACE and bleeding events. Results Almost half of patient were grouped in CKD stage 2 (n=4895, 45%) which was followed by stage 3a (n=2686, 24.7%), stage 3b (n=1359, 12.5%), stage 1 (n=1045, 9.6%), stage 4 (n=471, 4.3%) and stage 5 (n=414, 3.8%). As shown in Table 1 (Patient characteristics), CKD staging had positive correlation with age, hypertension, diabetes, atrial fibrillation, and previous MI but had negative correlation with dyslipidemia and smoking. As shown in Table 2 (AMI characteristics), proportion of non-ST elevation MI was greater in CKD stage 4 and 5 which leaded to lower peak CK level and longer door to device time. Percentage of Killip 4 increased from stage 3a (12.2%) and exceeded 20% from stage 3b resulting in greater demand for mechanical devices. Each CKD staging had quite distinct and significant impact on MACE, bleeding, and composite events as shown in Kaplan-Meier curve of figure 1A∼C. After adjustment with multiple confounding factors, composite events still significantly differ from stage 3B (Adjusted risk ratio: stage1, 1.1[0.4-2.6]; stage2; 1.1[0.6-2.0], stage 3a, 1[reference]; stage 3b, 1.8 [1.0-3.2]; stage 4, 2.4 [1.3-4.5]; stage 5, 4.1 [1.6-10.7]). Conclusion Each CKD staging had distinct clinical feature with significant impact on clinical outcome.