Post-Heart Attack Mortality Declining in Kidney Disease Patients

Mortality after myocardial infarction (MI) has been declining among patients with chronic kidney disease (CKD), according to researchers.

In a study of 12,087 patients hospitalized for MI over a 24-year period (1985-2008), the 30-day mortality risk in patients with stage 2-5 CKD decreased from 11% in 1985-1990 to 6% in 2000-2008. The five-year mortality rate decreased from 26% to 24%.

Among patients with stage 2 CKD, those hospitalized for an MI in 2000-2008 had a 67% decreased 30-day mortality risk compared with those hospitalized for an MI in 1985-1990 in adjusted analyses, researchers reported in Kidney International (2013;84:353-358). For patients with stage 3 and stage 4-5 CKD, the decrease in 30-day mortality risk after hospitalization for MI between the two periods was 46% and 67%, respectively.

Among patients hospitalized for MI and who survived beyond 30 days, the five-year mortality risk for patients with stage 2, 3, and 4-5 CKD decreased by 15%, 20%, 4%, and 10%, respectively, from 1985-1990 to 2000-2008.

Improved 30-day and five-year survival also was observed among MI patients without CKD. The risk of 30-day and five-year mortality decreased by 79% and 15% from 1985-1990 to 2000-2008.

The authors noted that in recent decades, major improvements in the treatment of MI have been implemented. These improvements include thrombolytic therapy and primary percutaneous coronary intervention for ST-elevation MI.

“Temporal trends in 30-day mortality reveal impressive mortality reductions during this 24-year period that were comparable for all stages of renal function and were sustained during long-term follow-up,” Sjoerd T. Nauta, MD, and colleagues at Erasmus Medical Center in Rotterdam, The Netherlands, wrote. “Although the outcome after MI improved across the whole range of renal function, we showed that renal dysfunction remains a strong risk factor for increased both short- and long-term mortality.”

Compared with patients who had normal renal function, patients with stage 4 and stage 5 CKD had an 8.5-fold and 8.8-fold higher adjusted 30-day mortality risk, respectively, according to the researchers. Patients with stage 4 and stage 5 CKD had a 3.3-fold and 8.0-fold higher mortality risk between 30 days and five years compared with patients who had normal renal function.

In an editorial accompanying the study, Gautam R. Shroff, MD, and Charles A. Herzog, MD, of the Hennepin County Medical Center in Minneapolis, observed that, despite the limitations of the study, “these observational data tell an informative and optimistic story of temporal reduction in 30-day mortality among patients with various degrees of renal dysfunction … in the most recent decade.”

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