Introduction:
We assessed the interplay and potential cumulative effects of heart failure (HF) and chronic kidney disease (CKD) on one-year and 5-year outcomes in patients admitted for acute myocardial infarction (AMI).
Methods:
FAST-MI consists of 3 nationwide French surveys 5 years apart from 2005 to 2015, consecutively including STEMI and NSTEMI patients over 1-month periods. Using Cox regression, we analysed the association between CKD and non-fatal HF and death during the first year after discharge according to absence of HF, previous HF and acute stage HF. In those alive at 1 year, we also analysed the prognostic significance of admission for non-fatal HF after AMI and CKD on 5-year mortality.
Results:
Of 12,301 patients discharged alive, 7960 (64.7%) had normal renal function and no HF. Both CKD and type of HF were independent predictors of one-year death: one-year mortality was 3.6%, 14.3% and 24.5% in patients with no HF, acute stage HF, and prior history of HF, respectively. Within each group, mortality increased by increasing degree of CKD. In patients with no history of HF, CKD was a strong independent correlate of hospital admission for HF within one year of discharge: HR (95%CI) 1.33 (1.01-1.74), P=0.04 for CKD-EPI 30-60, and 1.76 (1.16-2.67), P=0.008 for CKD-EPI <30, as was the case in patients with HF at the acute stage (Figure). Finally, in patients alive at 1year, both HF admission during the first year (adjusted HR 1.85, 1.42-2.39, P<0.001) and CKD (HR 1,23, 1.04-1.47, P=0.02 and HR 1.86, 1.41-2.44, P<0.001, respectively for moderate and severe renal dysfunction), were independent predictors of 5-year death.
Conclusion:
After AMI, CKD and HF are major independent prognostic factors for death and/or subsequent HF admission. Both are likely to be important therapeutic targets to improve long-term outcomes after AMI.
In-hospital heart failure, first-year ventricular dilatation and 10-year survival after acute myocardial infarction
