Renal insufficiency impacts on early and late mortality after acute coronary syndrome after adjustment for comorbidities and management. Insights from the FAST MI 2005 registry

Abstract

Background: There is excess mortality in patients (pts) with renal insufficiency (RI) and acute coronary syndrome (ACS) due to comorbidities, increased hemorrhagic & thrombotic risks and suboptimal management. We investigated the impact of RI itself on acute and long term outcomes after MI, after adjustment for comorbidities and management. Methods: FAST-MI is a nationwide French registry that included consecutive pts with AMI in 223 centres in 2005. Baseline characteristics and management were compared between groups according to RI status at inclusion. All-cause mortality at 30 days and 5 years were compared between RI groups by Cox multivariate analysis and paired comparison (matched on a propensity score to have RI). Results: Of 3670 AMI pts included, 1537 (41.9%) had RI (creatinine clearance≤60 ml/min). RI pts were older, more often diabetic and smokers, more often had a history of hypertension, heart failure, stroke, peripheral arterial disease and anemia, had longer time to treatment and higher Killip class. RI pts less frequently received aspirin, thienopyridines, ACEI/ARB and less often underwent revascularisation. In-hospital death was 3 times higher in RI pts (10.8 vs 3%, p<0.0001), and 5 year mortality was more than twice as high (51% vs 18%, p<0.0001). After adjustment for baseline characteristics, comorbidities and management, RI was associated with higher 30-day (hazard ratio, HR 1.8 [1.2; 2.7]) and 5 year mortality (HR 1.45 [1.18; 1.8]) and higher 5 year mortality among survivors at 30 days (HR 1.47 [1.2; 1.8]). After matching on a propensity score, in-hospital and 5 year mortality remained higher in RI pts (figure). ![Figure][1] Conclusions: Pts with RI are at increased risk of early and late death, independently of comorbidities and management. [1]: pending:yes