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

Michael G. Shlipak, Paul A. Heidenreich, Haruko Noguchi, Glenn M. Chertow, Warren S. Browner, Mark B. McClellan

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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 μmol/L] iLmol/Ll; n = 82 455), mild renal insufficiency (creatinine level, 1.5 to 2.4 mg/dL [132 to 212 μmol/L]; n = 36 756), or moderate renal insufficiency (creatinine level, 2.5 to 3.9 mg/dL [221 to 345 μmol/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, β-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% Cl, 1.63 to 1.73]) and moderate (hazard ratio, 2.35 [Cl, 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.

Original languageEnglish
Pages (from-to)555-562
Number of pages8
JournalAnnals of Internal Medicine
Volume137
Issue number7
Publication statusPublished - 2002 Oct 1
Externally publishedYes

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ASJC Scopus subject areas

  • Medicine(all)

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Shlipak, M. G., Heidenreich, P. A., Noguchi, H., Chertow, G. M., Browner, W. S., & McClellan, M. B. (2002). Association of renal insufficiency with treatment and outcomes after myocardial infarction in elderly patients. Annals of Internal Medicine, 137(7), 555-562.