MI Patients with CKD Get Worse Care
NEW ORLEANS—MI patients who have CKD are less likely to receive evidence-based therapies for MI and are more likely to die than those without CKD, Stephen D. Wiviott, MD, said at the 2008 scientific sessions of the American Heart Association.
His conclusions are derived from an examination of the National Cardiovascular Data Registry, known as the ACTION registry, a database of almost 50,000 patients with acute MI admitted to 274 hospitals in the United States during 2007.
“We do know that patients with CKD have poor outcomes following acute MI but because of methodologic issues with previous studies, including inaccurate methods of categorizing CKD, the limitations of using dialysis patients, or using populations derived from clinical trials—which can exclude patients with moderate to severe kidney disease—we felt that the prevalence and outcomes of patients with moderate to severe kidney disease have not been well studied,” Dr. Wiviott said.
The Modified Diet in Renal Disease (MDRD) study equation was used to estimate glomerular filtration rate (eGFR). CKD was defined as an eGFR of less than 60 mL/min/1.73 m2. CKD was further divided into stage 3 (30-59), stage 4 (15-29), and stage 5 (less than 15) or on hemodialysis.
Among the patients in the registry, 30.5% of those with ST-elevation MI and 42.9% with non-ST-elevation MI had CKD (predominantly stage 3).
In-hospital mortality ranged from an unadjusted rate of 2.3%with stage 3 CKD to 31% with stage 5 kidney disease. When adjusted for baseline factors, CKD patients were 2.9 to 7.7 times more likely to die compared with non-CKD patients, said Dr. Wiviott, assistant professor of medicine, Harvard Medical School, and associate physician, Brigham and Women's Hospital, Boston.