Management and Outcomes of Renal Disease and Acute Myocardial Infarction

Santolucito, Paul A.; Tighe, Dennis A.; McManus, David D.; Yarzebski, Jorge; Lessard, Darleen; Gore, Joel M.; Goldberg, Robert J.

doi:10.1016/j.amjmed.2010.04.025

« Previous Next »The American Journal of Medicine
Volume 123, Issue 9 , Pages 847-855, September 2010

Management and Outcomes of Renal Disease and Acute Myocardial Infarction

Paul A. Santolucito, MD
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Mass
Dennis A. Tighe, MD
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Mass
David D. McManus, MD
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Mass
Jorge Yarzebski, MD, MPH
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
Darleen Lessard, MS
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
Joel M. Gore, MD
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Mass
Robert J. Goldberg, PhD
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Mass
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
- Requests for reprints should be addressed to Robert J. Goldberg, PhD, Division of Epidemiology, Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655

Abstract

Background

Contemporary trends in the management and outcomes of chronic kidney disease patients who develop an acute myocardial infarction have not been adequately described, particularly from the more generalizable perspective of a population-based investigation.

Methods

The study population consisted of 6219 residents of the Worcester, Massachusetts, metropolitan area who were hospitalized with acute myocardial infarction in 6 annual periods between 1995 and 2005. Patients were categorized as having preserved kidney function (n=3154), mild to moderate chronic kidney disease (n=2313), or severe chronic kidney disease (n=752) at the time of hospital admission.

Results

Patients with chronic kidney disease were more likely to be older, to have a greater prevalence of comorbidities, and to experience significant in-hospital complications or die during hospitalization in comparison with patients with preserved kidney function. Although patients with chronic kidney disease were less likely to receive effective cardiac medications or undergo coronary interventional procedures than patients without kidney disease, we observed a marked increase in the use of effective cardiac medications and coronary interventional procedures in patients with chronic kidney disease during the period under study. In-hospital death rates declined over time among patients with chronic kidney disease, whereas these death rates remained unchanged among persons with normal kidney function.

Conclusion

The results of this study in residents of a large New England metropolitan area provide insights into changing trends in the treatment and impact of chronic kidney disease in patients hospitalized with acute myocardial infarction.

Keywords: Acute myocardial infarction, Long-term trends and outcomes, Population-based study, Renal disease