The prognostic impact of renal function decline during hospitalization for myocardial infarction

2021 ◽  
Vol 10 (3) ◽  
pp. 219-228
Author(s):  
Otto Mayer ◽  
Jitka Seidlerová ◽  
Jan Bruthans ◽  
Jan Opatrný ◽  
Milan Hromádka ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Renal Function ◽  
Risk Ratio ◽  
Mortality Risk ◽  
Prognostic Indicator ◽  
Prognostic Impact ◽  
Normal Functions ◽  
Hazard Risk ◽  
Moderate Renal Insufficiency ◽  
Similar Risk

Aim: We analyzed the mortality risk of myocardial infarction (MI) patients according to renal function, observed during hospitalization. Materials & methods: Patients hospitalized for MI between 2006 and 2018 were followed (n = 5659). We divided the sample into four groups by estimated glomerular filtration (eGFR) [ml/min]: normal functions (lowest eGFR during hospitalization >60); transiently moderate insufficiency (lowest eGFR >30 and ≤60, highest >60); permanently moderate insufficiency (highest eGFR >30 and ≤60); severe insufficiency (highest and lowest eGFR ≤30). Results: Permanently moderate renal insufficiency indicates increased 5-years all-cause mortality (hazard risk ratio: 2.27 [95% CIs: 1.87–2.75], p < 0.0001), but a similar risk was found in patients with the only transient decline of renal functions (hazard risk ratio: 2.08 [95% CIs: 1.70–2.55], p < 0.0001). Both moderate insufficiency subgroups (transient/permanent) did not statistically differ regarding mortality risk. Conclusion: Even just fluctuation of eGFR toward moderate insufficiency during hospitalization represents an important prognostic indicator in MI patients.

scholarly journals Short‐ and Long‐Term Clinical Outcomes for Patients With Takotsubo Syndrome and Patients With Myocardial Infarction: A Report From the Swedish Coronary Angiography and Angioplasty Registry

2021 ◽  
Vol 10 (17) ◽  
Author(s):  
Björn Redfors ◽  
Sandeep Jha ◽  
Sigurdur Thorleifsson ◽  
Tomas Jernberg ◽  
Oskar Angerås ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Coronary Angiography ◽  
Cardiogenic Shock ◽  
Acute Heart Failure ◽  
Mortality Risk ◽  
Takotsubo Syndrome ◽  
Killip Class ◽  
St Segment Elevation ◽  
Similar Risk

Background Takotsubo syndrome (TS) is a potentially life‐threatening acute cardiac syndrome with a clinical presentation similar to myocardial infarction and for which the natural history, management, and outcome remain incompletely understood. Our aim was to assess the relative short‐term mortality risk of TS, ST‐segment–elevation myocardial infarction (STEMI), and non‐STEMI (NSTEMI) and to identify predictors of in‐hospital complications and poor prognosis in patients with TS. Methods and Results This is an observational cohort study based on the data from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry). We included all patients (n=117 720) who underwent coronary angiography in Sweden attributed to TS (N=2898 [2.5%]), STEMI (N=48 493 [41.2%]), or NSTEMI (N=66 329 [56.3%]) between January 2009 and February 2018. We compared patients with TS to those with NSTEMI or STEMI. The primary end point was all‐cause mortality at 30 days. Secondary outcomes were acute heart failure (Killip Class ≥2) and cardiogenic shock (Killip Class 4) at the time of angiography. Patients with TS were more often women compared with patients with STEMI or NSTEMI. TS was associated with unadjusted and adjusted 30‐day mortality risks lower than STEMI (adjusted hazard ratio [adjHR], 0.60; 95% CI, 0.48–0.76; P <0.001), but higher than NSTEMI (adjHR, 2.70; 95% CI, 2.14–3.41; P <0.001). Compared with STEMI, TS was associated with a similar risk of acute heart failure (adjHR, 1.26; 95% CI, 0.91–1.76; P =0.16) but a lower risk of cardiogenic shock (adjHR, 0.55; 95% CI, 0.34–0.89; P =0.02). The relative 30‐day mortality risk for TS versus STEMI and NSTEMI was higher for smokers than nonsmokers (adjusted P interaction STEMI=0.01 and P interaction NSTEMI=0.01). Conclusions The 30‐day mortality rate in TS was higher than in NSTEMI but lower than STEMI despite a similar risk of acute heart failure in TS and STEMI. Among patients with TS, smoking was an independent predictor of mortality.

Uricemia in the acute phase of myocardial infarction and its relation to long-term mortality risk

2021 ◽  
Author(s):  
Milan Hromadka ◽  
Jan Opatrny ◽  
Roman Miklik ◽  
David Suchy ◽  
Jan Bruthans ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Uric Acid ◽  
Acute Phase ◽  
Risk Ratio ◽  
Cardiovascular Mortality ◽  
Mortality Rates ◽  
Cardiovascular Risk Reduction ◽  
Hazard Risk ◽  
Increased Risk

Aim: Although uric acid has antioxidant effects, hyperuricemia has been established as an indicator of increased cardiovascular mortality in various patient populations. Treatment of asymptomatic hyperuricemia in patients with acute myocardial infarction (MI) is not routinely recommended, and the efficacy of such treatment in terms of cardiovascular risk reduction remains doubtful. Materials & methods: In a prospective cohort study, we followed 5196 patients admitted for a MI between 2006 and 2018. We assessed the relationship between baseline uricemia and the incidence of all-cause death and cardiovascular mortality and the effect of long-term allopurinol treatment. Hyperuricemia was defined as serum uric acid >450 μmol/l in men and >360 μmol/l in women. Results: In the entire cohort, the 1-year all-cause and cardiovascular mortality rates were 8 and 7.4%, and the 5-year rates were 18.3 and 15.3%, respectively. Using a fully adjusted model, hyperuricemia was associated with a 70% increased risk of both all-cause death and cardiovascular mortality at 1 year, and the negative prognostic value of hyperuricemia persisted over the 5-year follow-up (for all-cause death, hazard risk ratio = 1.45 [95% CI: 1.23–1.70] and for cardiovascular mortality, hazard risk ratio = 1.52 [95% CI: 1.28–1.80], respectively). Treatment of asymptomatic hyperuricemia with allopurinol did not affect mortality rates. Conclusion: Hyperuricemia detected in patients during the acute phase of an MI appears to be independently associated with an increased risk of subsequent fatal cardiovascular events. However, hyperuricemia treatment with low-dose allopurinol did not prove beneficial for these patients.

scholarly journals Renal Function Effect on the Association Between Body Mass Index and Mortality Risk After Acute Myocardial Infarction

2021 ◽  
Vol 8 ◽  
Author(s):  
Shin Yeong Kang ◽  
Weon Kim ◽  
Jin Sug Kim ◽  
Kyung Hwan Jeong ◽  
Myung Ho Jeong ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Body Mass Index ◽  
Renal Function ◽  
Body Mass ◽  
Mortality Risk ◽  
Cardiac Death ◽  
Survival Benefit ◽  
Interactive Effects ◽  
All Cause Mortality

Background: Body mass index (BMI) is a critical determinant of mortality after acute myocardial infarction (AMI), and higher BMI is associated with survival benefit in patients with renal impairment. However, there are no studies investigating the interactive effects of BMI and renal function on mortality risk after AMI occurrence.Methods: We enrolled 12,647 AMI patients from Korea Acute Myocardial Infarction Registry between November 2011 and December 2015. Patients were categorized based on estimated Glomerular Filtration Rate (eGFR) and BMI. The primary endpoint was all-cause mortality after AMI treatment.Results: Within each renal function category, the absolute mortality rate was decreased in patients with higher BMI. However, the adjusted hazard ratio (HR) of all-cause mortality for higher BMI was decreased as renal function worsened [adjusted HR (95% confidence interval) at BMI ≥ 25 kg/m2: 0.63 (0.41–0.99), 0.76 (0.59–0.97), and 0.84 (0.65–1.08) for patients with eGFR ≥ 90, 90–45, and &lt;45 mL/min/1.73 m2, respectively]. There was a significant interaction between BMI and renal function (P for interaction = 0.010). The protective effect of higher BMI was preserved against non-cardiac death and it was also decreased with lowering eGFR in competing risks models [adjusted HR at BMI ≥25 kg/m2: 0.38 (0.18–0.83), 0.76 (0.59–0.97), and 0.84 (0.65–1.08) for patients with eGFR ≥ 90, 90–45, and &lt;45 mL/min/1.73 m2, respectively; P for interaction = 0.03]. However, renal function did not significantly affect the association between BMI and risk of cardiac death (P for interaction = 0.20).Conclusions: The effect of BMI on the mortality risk after AMI was dependent on renal function. The association between greater BMI and survival benefit was weakened as renal function was decreased. In addition, the negative effect of renal function on the BMI – mortality association was pronounced in the non-cardiac death.

Prognostic significance of ankle brachial pressure index: A systematic review and meta-analysis

Vascular ◽  
2016 ◽  
Vol 25 (2) ◽  
pp. 208-224 ◽  
Author(s):  
Shahab Hajibandeh ◽  
Shahin Hajibandeh ◽  
Sohan Shah ◽  
Emma Child ◽  
George A Antoniou ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Ratio ◽  
Mortality Risk ◽  
Meta Analysis ◽  
Morbidity And Mortality ◽  
Cerebrovascular Event ◽  
Ankle Brachial Pressure Index ◽  
Pressure Index ◽  
Increased Risk ◽  
Co Morbidity

Purpose To synthesize and quantify the excess risk of morbidity and mortality in individuals with low ankle-brachial pressure index. Methods Electronic databases were searched to identify studies investigating morbidity and mortality outcomes in individuals undergoing ankle-brachial pressure index measurement. Meta-analysis of the outcomes was performed using fixed- or random-effects models. Uncertainties related to varying follow-up periods among the studies were resolved by meta-analysis of time-to-event outcomes. Results Forty-three observational cohort studies, enrolling 94,254 participants, were selected. A low ankle-brachial pressure index (<0.9) was associated with a significant risk of all-cause mortality (risk ratio: 2.52, 95% CI 2.26–2.82, P < 0.00001); cardiovascular mortality (risk ratio: 2.94, 95% CI 2.72–3.18, P < 0.00001); cerebrovascular event (risk ratio: 2.17, 95% CI 1.90–2.47, P < 0.00001); myocardial infarction (risk ratio: 2.28, 95% CI 2.07–2.51, P < 0.00001); fatal myocardial infarction (risk ratio: 2.81, 95% CI 2.33–3.40, P < 0.00001); fatal stroke (risk ratio: 2.28, 95% CI 1.80–2.89, P < 0.00001); and the composite of myocardial infarction, stroke, and death (risk ratio: 2.29, 95% CI 1.87–2.81, P < 0.00001). Similar findings resulted from analyses of individuals with asymptomatic PAD, individuals with cardiovascular or cerebrovascular co-morbidity, and patients with diabetes. Conclusions A low ankle-brachial pressure index is associated with an increased risk of subsequent cardiovascular and cerebrovascular morbidity and mortality. Randomised controlled trials are required to investigate the effectiveness of screening for PAD in asymptomatic and undiagnosed individuals and to evaluate benefits of early treatment of screen-detected PAD.

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