Abstract
BackgroundRenal function is an important predictor of mortality in patients with myocardial infarction (MI), but changes in the impact over time have not been well described.We examined the importance of renal function by estimated GFR (eGFR) and se-creatinine as an independent long-term prognostic factor.MethodsProspective follow-up of 6653 consecutive MI patients screened for entry in the Trandolapril Cardiac Evaluation (TRACE) study. The patients were analysed by Kaplan-Meier survival analysis, landmark analysis and Cox proportional hazard models. Outcome measure was all-cause mortality.ResultsAn eGFR below 60 ml per minute per 1.73 m2, consistent with chronic renal disease, was present in 42% of the patients. We divided the patients into 4 groups according to eGFR. Overall, Cox proportional-hazards models showed that eGFR was a significant prognostic factor in the two groups with the lowest eGFR, hazard ratio 1,72 (confidence interval (CI) 1,56-1,91) in the group with the lowest eGFR. Using the eGFR group with normal renal function as reference, we observed an incremental rise in hazard ratio. We divided the follow-up period in 2-year intervals. Landmark analysis showed that eGFR at the time of screening continued to show prognostic effect until 16 years of follow-up. By multivariable Cox regression analysis, the prognostic effect of eGFR persisted for 12 years and of se-creatinine for 10 years. When comparing the lowest group of eGFR with the group with normal eGFR, prognostic significance was present in the entire period of follow-up with a hazard ratio between 1,97 (CI 1,65-2,35) and 1,35 (CI 0,99-1,84) in the 2-year periods.ConclusionsOne estimate of renal function is a strong and independent long-term prognostic factor for 10-12 years following a MI.
Highlights
Renal function is an important predictor of mortality in patients with myocardial infarction (MI), but changes in the impact over time have not been well described
We undertook a retrospective study of 6676 patients admitted with myocardial infarction and who were screened for entry in the Trandolapril Cardiac Evaluation
Renal function was evaluated by estimated GFR and s-creatinine and patients were followed for up to 17 years to systematically evaluate the importance of renal function as an independent prognostic factor evaluated at the time of the index infarction
Summary
Renal function is an important predictor of mortality in patients with myocardial infarction (MI), but changes in the impact over time have not been well described. We examined the importance of renal function by estimated GFR (eGFR) and se-creatinine as an independent long-term prognostic factor. The significance of impairment of kidney function for cardiovascular outcome after myocardial infarction (MI) has been examined in patients with heart failure [5], impaired left ventricular function [6] and in patients undergoing coronary artery bypass grafting (CABG) [7]. Several studies have examined cardiovascular outcomes in patients with end-stage renal disease but data on the risk in patients with lesser degrees of renal. Renal function was evaluated by estimated GFR and s-creatinine and patients were followed for up to 17 years to systematically evaluate the importance of renal function as an independent prognostic factor evaluated at the time of the index infarction
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