Abstract

Retrospective Study

Impact of Chronic Kidney Disease on Major Adverse Cardiac Events in Patients with Acute Myocardial Infarction: A Retrospective Cohort Study

Abbas Andishmand, Ehsan Zolfeqari*, Mahdiah Sadat Namayandah and Hossein Montazer Ghaem

Published: 05 February, 2024 | Volume 9 - Issue 1 | Pages: 029-034

Background: Acute Myocardial Infarction (AMI) results in a reduction in patients’ life expectancy. Different risk factors affect the risk of Major Adverse Cardiac Events (MACE). Although the role of kidney dysfunction in patients with Chronic Kidney Disease (CKD) in cardiac events has been identified, many patients with AMI are unaware of their underlying kidney disease. This study aimed to compare the incidence of adverse cardiovascular events and identify predictors of major adverse cardiovascular events in the medium term among patients with and without renal dysfunction following AMI. 
Methods: This retrospective cohort study was conducted on 1039 patients who were hospitalized for Acute Myocardial Infarction (AMI) between 2018 and 2019. The patient cohort comprised 314 women (mean age: 69.8 ± 13.2 years) and 725 men (mean age: 60.5 ± 13.8 years). Patient data were obtained from the registry of patients with acute myocardial infarction and the participants were followed up for a minimum of one year following hospital discharge to assess the incidence of MACE.
Results: The study found that patients with a Glomerular Filtration Rate (GFR) level below 60 had a significantly higher mortality rate than those with a GFR level of 60 or above (15.7% vs. 3.5%,
p < 0.0001). The multivariate analysis showed that Diabetes Mellitus (DM), GFR, and Non-ST Elevation Myocardial Infarction (NSTEMI) are significant risk factors for cardiovascular events. 
(p = 0.016, p = 0.015, p = 0.006 respectively), while variables such as sex, age, and Hypertension (HTN) were not significant risk factors. There was a negative correlation between GFR and death (0.241 - = r, p < 0.0001)
Conclusion: This study highlights the importance of detecting kidney disease during an AMI and managing risk factors for cardiovascular disease to improve health outcomes and reduce the risk of mortality.

Read Full Article HTML DOI: 10.29328/journal.jccm.1001175 Cite this Article Read Full Article PDF

Keywords:

Major adverse cardiac event; Glomerular filtration rate; Acute myocardial infarction; Chronic kidney disease

References

  1. Smith GL, Masoudi FA, Shlipak MG, Krumholz HM, Parikh CR. Renal impairment predicts long-term mortality risk after acute myocardial infarction. J Am Soc Nephrol. 2008 Jan;19(1):141-50. doi: 10.1681/ASN.2007050554. Epub 2007 Nov 14. PMID: 18003773; PMCID: PMC2391037.
  2. Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, McCullough PA, Kasiske BL, Kelepouris E, Klag MJ, Parfrey P, Pfeffer M, Raij L, Spinosa DJ, Wilson PW; American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation. 2003 Oct 28;108(17):2154-69. doi: 10.1161/01.CIR.0000095676.90936.80. PMID: 14581387.
  3. Nestelberger T, Boeddinghaus J, Wussler D, Twerenbold R, Badertscher P, Wildi K, Miró Ò, López B, Martin-Sanchez FJ, Muzyk P, Koechlin L, Baumgartner B, Meier M, Troester V, Rubini Giménez M, Puelacher C, du Fay de Lavallaz J, Walter J, Kozhuharov N, Zimmermann T, Gualandro DM, Michou E, Potlukova E, Geigy N, Keller DI, Reichlin T, Mueller C; APACE Investigators. Predicting Major Adverse Events in Patients with Acute Myocardial Infarction. J Am Coll Cardiol. 2019 Aug 20;74(7):842-854. doi: 10.1016/j.jacc.2019.06.025. PMID: 31416527.
  4. Chen W, Tan X, Du X, Li Q, Yuan M, Ni H, Wang Y, Du J. Prediction models for major adverse cardiovascular events following ST-segment elevation myocardial infarction and subgroup-specific performance. Front Cardiovasc Med. 2023 Apr 25; 10:1181424. doi: 10.3389/fcvm.2023.1181424. PMID: 37180806; PMCID: PMC10167292.
  5. Janjani P, Motevaseli S, Salehi N, Heidari Moghadam R, Siabani S, Nalini M. Predictors of 1-Year Major Cardiovascular Events after ST-Elevation Myocardial Infarction in a Specialized Cardiovascular Center in Western Iran. J Tehran Heart Cent. 2022 Apr;17(2):62-70. doi: 10.18502/jthc.v17i2.9839. PMID: 36567930; PMCID: PMC9748231.
  6. Sattar S, Hussain S, Aijaz S, Khan G, Akhter Z, Malik R, Ali I, Pathan A. Major adverse cardiovascular events in patients undergoing percutaneous coronary intervention or coronary artery bypass graft with underlying chronic kidney disease. J Pak Med Assoc. 2020 Nov;70(11):1901-1907. doi: 10.5455/JPMA.22790. PMID: 33341827.
  7. Goldberg A, Hammerman H, Petcherski S, Zdorovyak A, Yalonetsky S, Kapeliovich M, Agmon Y, Markiewicz W, Aronson D. Inhospital and 1-year mortality of patients who develop worsening renal function following acute ST-elevation myocardial infarction. Am Heart J. 2005 Aug;150(2):330-7. doi: 10.1016/j.ahj.2004.09.055. PMID: 16086939.
  8. Fox CS, Muntner P, Chen AY, Alexander KP, Roe MT, Cannon CP, Saucedo JF, Kontos MC, Wiviott SD; Acute Coronary Treatment and Intervention Outcomes Network registry. Use of evidence-based therapies in short-term outcomes of ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction in patients with chronic kidney disease: a report from the National Cardiovascular Data Acute Coronary Treatment and Intervention Outcomes Network registry. Circulation. 2010 Jan 26;121(3):357-65. doi: 10.1161/CIRCULATIONAHA.109.865352. Epub 2010 Jan 11. PMID: 20065168; PMCID: PMC2874063.
  9. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004 Sep 23;351(13):1296-305. doi: 10.1056/NEJMoa041031. Erratum in: N Engl J Med. 2008;18(4):4. PMID: 15385656.
  10. Herzog CA, Ma JZ, Collins AJ. Poor long-term survival after acute myocardial infarction among patients on long-term dialysis. N Engl J Med. 1998 Sep 17;339(12):799-805. doi: 10.1056/NEJM199809173391203. PMID: 9738087.
  11. Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, De Zeeuw D, Hostetter TH, Lameire N, Eknoyan G. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2005 Jun;67(6):2089-100. doi: 10.1111/j.1523-1755.2005.00365.x. PMID: 15882252.
  12. Lv JC, Zhang LX. Prevalence and Disease Burden of Chronic Kidney Disease. Adv Exp Med Biol. 2019; 1165:3-15. doi: 10.1007/978-981-13-8871-2_1. PMID: 31399958.
  13. Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl (2011). 2022 Apr;12(1):7-11. doi: 10.1016/j.kisu.2021.11.003. Epub 2022 Mar 18. PMID: 35529086; PMCID: PMC9073222.
  14. van der Velde M, Matsushita K, Coresh J, Astor BC, Woodward M, Levey A, de Jong P, Gansevoort RT; Chronic Kidney Disease Prognosis Consortium; van der Velde M, Matsushita K, Coresh J, Astor BC, Woodward M, Levey AS, de Jong PE, Gansevoort RT, Levey A, El-Nahas M, Eckardt KU, Kasiske BL, Ninomiya T, Chalmers J, Macmahon S, Tonelli M, Hemmelgarn B, Sacks F, Curhan G, Collins AJ, Li S, Chen SC, Hawaii Cohort KP, Lee BJ, Ishani A, Neaton J, Svendsen K, Mann JF, Yusuf S, Teo KK, Gao P, Nelson RG, Knowler WC, Bilo HJ, Joosten H, Kleefstra N, Groenier KH, Auguste P, Veldhuis K, Wang Y, Camarata L, Thomas B, Manley T. Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality. A collaborative meta-analysis of high-risk population cohorts. Kidney Int. 2011 Jun;79(12):1341-52. doi: 10.1038/ki.2010.536. Epub 2011 Feb 9. PMID: 21307840.
  15. Jankowski J, Floege J, Fliser D, Böhm M, Marx N. Cardiovascular Disease in Chronic Kidney Disease: Pathophysiological Insights and Therapeutic Options. Circulation. 2021 Mar 16;143(11):1157-1172. doi: 10.1161/CIRCULATIONAHA.120.050686. Epub 2021 Mar 15. PMID: 33720773; PMCID: PMC7969169.
  16. Kaufman DP, Basit H, Knohl SJ. Physiology, Glomerular Filtration Rate. In: StatPearls. Treasure Island (FL): StatPearls. 2023; PMID: 29763208.
  17. Stevens LA, Coresh J, Greene T, Levey AS. Assessing kidney function--measured and estimated glomerular filtration rate. N Engl J Med. 2006 Jun 8;354(23):2473-83. doi: 10.1056/NEJMra054415. PMID: 16760447.
  18. Ebert N, Bevc S, Bökenkamp A, Gaillard F, Hornum M, Jager KJ, Mariat C, Eriksen BO, Palsson R, Rule AD, van Londen M, White C, Schaeffner E. Assessment of kidney function: clinical indications for measured GFR. Clin Kidney J. 2021 Feb 22;14(8):1861-1870. doi: 10.1093/ckj/sfab042. PMID: 34345408; PMCID: PMC8323140.
  19. Hussain J, Grubic N, Akbari A, Canney M, Elliott MJ, Ravani P, Tanuseputro P, Clark EG, Hundemer GL, Ramsay T, Tangri N, Knoll GA, Sood MM. Associations between modest reductions in kidney function and adverse outcomes in young adults: retrospective, population based cohort study. BMJ. 2023 Jun 22; 381:e075062. doi: 10.1136/bmj-2023-075062. PMID: 37353230; PMCID: PMC10286512.
  20. Cusumano AM, Tzanno-Martins C, Rosa-Diez GJ. The Glomerular Filtration Rate: From the Diagnosis of Kidney Function to a Public Health Tool. Front Med (Lausanne). 2021 Nov 25; 8:769335. doi: 10.3389/fmed.2021.769335. PMID: 34926510; PMCID: PMC8675900.
  21. Hill NR, Fatoba ST, Oke JL, Hirst JA, O'Callaghan CA, Lasserson DS, Hobbs FD. Global Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis. PLoS One. 2016 Jul 6;11(7):e0158765. doi: 10.1371/journal.pone.0158765. PMID: 27383068; PMCID: PMC4934905.
  22. Johansson S, Rosengren A, Young K, Jennings E. Mortality and morbidity trends after the first year in survivors of acute myocardial infarction: a systematic review. BMC Cardiovasc Disord. 2017 Feb 7;17(1):53. doi: 10.1186/s12872-017-0482-9. PMID: 28173750; PMCID: PMC5297173.
  23. Chaitman BR, Cyr DD, Alexander KP, Pracoń R, Bainey KR, Mathew A, Acharya A, Kunichoff DF, Fleg JL, Lopes RD, Sidhu MS, Anthopolos R, Rockhold FW, Stone GW, Maron DJ, Hochman JS, Bangalore S. Cardiovascular and Renal Implications of Myocardial Infarction in the ISCHEMIA-CKD Trial. Circ Cardiovasc Interv. 2022 Aug;15(8):e012103. doi: 10.1161/CIRCINTERVENTIONS.122.012103. Epub 2022 Aug 16. PMID: 35973009.
  24. Charytan DM, Kuntz RE, Mauri L, DeFilippi C, Ikonomidis JS, McLennan E, Robbins SL, Sabatine MS, Solomon SD, Steg PG, Stone GW, Zannad F, Pfeffer MA. Acute Myocardial Infarction in Patients with Chronic Kidney Disease: Lessons from the CARES Trial. JACC Cardiovasc Interv. 2020 May 11;13(9):1050-1062. doi 10.1016/j.jcin.2020.02.002. PMID: 32381447.
  25. Hu SS, Wang X, Ye P, Liu Y, Yang Q, Ye Z, Xie Y, Hu R, Xue J, Li J, Chen J. Impact of estimated glomerular filtration rate on long-term clinical outcomes in patients with acute myocardial infarction: a retrospective cohort study. BMC Cardiovasc Disord. 2021 Mar 5;21(1):115. doi 10.1186/s12872-021-01908-0. PMID: 33673756; PMCID: PMC7938314.
  26. Li X, Li C, Liang H, Xu W, Chen Y, Xiong C, Zhang X, Huang Y, Liang W, Liu X. Association between glomerular filtration rate and clinical outcomes in patients with acute myocardial infarction: a retrospective cohort study. BMC Cardiovasc Disord. 2021 Oct 5;21(1):461. doi 10.1186/s12872-021-02341-0. PMID: 34611104; PMCID: PMC8485940.
  27. Wang Y, Zhang H, Wang Y, Wang J, Liang J, Wang X, Zhang J, Zhang Y. Association of estimated glomerular filtration rate with risk of mortality in patients with acute myocardial infarction. J Clin Lab Anal. 2021 May;35(5):e23706. doi 10.1002/jcla.23706. Epub 2021 Feb 24. PMID: 33624371.
  28. Ismail MD, Jalalonmuhali M, Azhari Z, Mariapun J, Lee ZV, Zainal Abidin I, Wan Ahmad WA, Zuhdi ASM; NCVD-PCI investigators. Outcomes of STEMI patients with chronic kidney disease treated with percutaneous coronary intervention: The Malaysian National Cardiovascular Disease Database - Percutaneous Coronary Intervention (NCVD-PCI) registry data from 2007 to 2014. BMC Cardiovasc Disord. 2018 Sep 24;18(1):184. doi: 10.1186/s12872-018-0919-9. PMID: 30249197; PMCID: PMC6154951.
  29. Major RW, Cheung CK, Gray LJ, Brunskill NJ. Statins and Cardiovascular Primary Prevention in CKD: A Meta-Analysis. Clin J Am Soc Nephrol. 2015 May 7;10(5):732-9. doi: 10.2215/CJN.07460714. Epub 2015 Apr 1. PMID: 25833405; PMCID: PMC4422238.
  30. Kofman N, Margolis G, Gal-Oz A, Letourneau-Shesaf S, Keren G, Rozenbaum Z, Shacham Y. Long-term renal outcomes and mortality following renal injury among myocardial infarction patients treated by primary percutaneous intervention. Coron Artery Dis. 2019 Mar;30(2):87-92. doi: 10.1097/MCA.0000000000000678. PMID: 30422833.
  31. Ocak G, Noordzij M, Rookmaaker MB, Cases A, Couchoud C, Heaf JG, Jager KJ. Mortality due to cardiovascular disease in patients with chronic kidney disease at different ages and stages: a nationwide cohort study. BMC Med. 2019 Mar 18;17(1):57. doi 10.1186/s12916-019-1298-4. PMID: 30885116; PMCID: PMC6425732.
  32. Bansal N, Szpiro AA, Reynolds K, Smith DH, Siscovick D, Fann N, Lumley T. Long-term exposure to ambient air pollution and renal function in older adults: The Cardiovascular Health Study. Environ Int. 2018 Oct; 119:310-319. doi 10.1016/j.envint.2018.06.027. Epub 2018 Jul 5. PMID: 29981997; PMCID: PMC6434893.
  33. Wang X, Guo Y, Ni Z, Jin Y, Wu J, Chen J. Cardiovascular disease and mortality in patients with chronic kidney disease and acute myocardial infarction: a systematic review and meta-analysis. Ren Fail. 2018 Nov;40(1):657-666. doi 10.1080/0886022X.2018.1488531. PMID: 30086677.
  34. Wu M, Ruan L, Sun Y, Liang Y, Li H, Huang C, Huang Y, Cai X, Huang X, Qin X. Association of serum uric acid levels with mortality in patients with acute myocardial infarction and chronic kidney disease. BMC Cardiovasc Disord. 2021 Jun 3;21(1):291. doi 10.1186/s12872-021-02050-6. PMID: 34082794; PMCID: PMC8170273.
  35. Fu Y, Sun H, Guo Z, Xu L, Yang X, Wang L, Li K, Chen M, Gao Y. A risk score model to predict in-hospital mortality of patients with end-stage renal disease and acute myocardial infarction. Intern Emerg Med. 2021 Jun;16(4):905-912. doi: 10.1007/s11739-020-02529-3. Epub 2020 Oct 19. PMID: 33078224.
  36. Bhandari S, Jain P. Management of acute coronary syndrome in chronic kidney disease. J Assoc Physicians India. 2012 Nov; 60:48-51. PMID: 23767202.
  37. Sacco A, Montalto C, Bravi F, Ruzzenenti G, Garatti L, Oreglia JA, Bartorelli AL, Crimi G, LA Vecchia C, Savonitto S, Leonardi S, Oliva FG, Morici N. Non-ST-elevation acute coronary syndrome in chronic kidney disease: prognostic implication of an early invasive strategy. Minerva Cardiol Angiol. 2023 Feb;71(1):44-50. doi: 10.23736/S2724-5683.21.05839-7. Epub 2022 Feb 25. PMID: 35212503.
  38. Sattar S, Ahmed N, Akhter Z, Aijaz S, Lakhani S, Malik R, Pathan A. In-Hospital outcomes in acute coronary syndrome patients with concomitant severe chronic kidney disease undergoing percutaneous coronary intervention. Pak J Med Sci. 2019 Mar-Apr;35(2):291-297. doi: 10.12669/pjms.35.2.276. PMID: 31086503; PMCID: PMC6500806.
  39. Jun M, Lv J, Perkovic V, Jardine MJ. Managing cardiovascular risk in people with chronic kidney disease: a review of the evidence from randomized controlled trials. Ther Adv Chronic Dis. 2011 Jul;2(4):265-78. doi: 10.1177/2040622311401775. PMID: 23251754; PMCID: PMC3513885.
  40. Luyckx VA, Tuttle KR, Garcia-Garcia G, Gharbi MB, Heerspink HJL, Johnson DW, Liu ZH, Massy ZA, Moe O, Nelson RG, Sola L, Wheeler DC, White SL. Reducing major risk factors for chronic kidney disease. Kidney Int Suppl (2011). 2017 Oct;7(2):71-87. doi: 10.1016/j.kisu.2017.07.003. Epub 2017 Sep 20. PMID: 30675422; PMCID: PMC6341126.

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