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Ann Intern Med. 2002 Oct 1;137(7):555-62.

Association of renal insufficiency with treatment and outcomes after myocardial infarction in elderly patients.

Author information

1
General Internal Medicine Section, Veterans Affairs Medical Center (111A1) and University of California, San Francisco, , 4150 Clement Street, San Francisco, CA 94121, USA. shlip@itsa.ucsf.edu

Abstract

BACKGROUND:

Patients with end-stage renal disease are known to have decreased survival after myocardial infarction, but the association of less severe renal dysfunction with survival after myocardial infarction is unknown.

OBJECTIVES:

To determine how patients with renal insufficiency are treated during hospitalization for myocardial infarction and to determine the association of renal insufficiency with survival after myocardial infarction.

DESIGN:

Cohort study.

SETTING:

All nongovernment hospitals in the United States.

PATIENTS:

130 099 elderly patients with myocardial infarction hospitalized between April 1994 and July 1995.

MEASUREMENTS:

Patients were categorized according to initial serum creatinine level: no renal insufficiency (creatinine level < 1.5 mg/dL [<132 micromol/L]; n = 82 455), mild renal insufficiency (creatinine level, 1.5 to 2.4 mg/dL [132 to 212 micromol/L]; n = 36 756), or moderate renal insufficiency (creatinine level, 2.5 to 3.9 mg/dL [221 to 345 micromol/L]; n = 10 888). Vital status up to 1 year after discharge was obtained from Social Security records.

RESULTS:

Compared with patients with no renal insufficiency, patients with moderate renal insufficiency were less likely to receive aspirin, beta-blockers, thrombolytic therapy, angiography, and angioplasty during hospitalization. One-year mortality was 24% in patients with no renal insufficiency, 46% in patients with mild renal insufficiency, and 66% in patients with moderate renal insufficiency (P < 0.001). After adjustment for patient and treatment characteristics, mild (hazard ratio, 1.68 [95% CI, 1.63 to 1.73]) and moderate (hazard ratio, 2.35 [CI, 2.26 to 2.45]) renal insufficiency were associated with substantially elevated risk for death during the first month of follow-up. This increased mortality risk continued until 6 months after myocardial infarction.

CONCLUSIONS:

Renal insufficiency was an independent risk factor for death in elderly patients after myocardial infarction. Targeted interventions may be needed to improve treatment for this high-risk population.

[Indexed for MEDLINE]

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