TY - JOUR
T1 - Association of renal insufficiency with treatment and outcomes after myocardial infarction in elderly patients
AU - Shlipak, Michael G.
AU - Heidenreich, Paul A.
AU - Noguchi, Haruko
AU - Chertow, Glenn M.
AU - Browner, Warren S.
AU - McClellan, Mark B.
PY - 2002/10/1
Y1 - 2002/10/1
N2 - 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.
AB - 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.
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U2 - 10.7326/0003-4819-137-7-200210010-00006
DO - 10.7326/0003-4819-137-7-200210010-00006
M3 - Article
C2 - 12353942
AN - SCOPUS:0036787985
VL - 137
SP - 555
EP - 562
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
SN - 0003-4819
IS - 7
ER -