Increased Mortality among Survivors of Myocardial Infarction with Kidney Dysfunction: the Contribution of Gaps in the use of Guideline-Based TherapiesReportar como inadecuado

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BMC Cardiovascular Disorders

, 9:29

First Online: 08 July 2009Received: 30 June 2008Accepted: 08 July 2009DOI: 10.1186-1471-2261-9-29

Cite this article as: Peterson, P.N., Ambardekar, A.V., Jones, P.G. et al. BMC Cardiovasc Disord 2009 9: 29. doi:10.1186-1471-2261-9-29


BackgroundWe assessed the degree to which differences in guideline-based medical therapy for acute myocardial infarction AMI contribute to the higher mortality associated with kidney disease.

MethodsIn the PREMIER registry, we evaluated patients from 19 US centers surviving AMI. Cox regression evaluated the association between estimated glomerular filtration rate GFR and time to death over two years, adjusting for demographic and clinical variables. The contribution of variation in guideline-based medical therapy to differences in mortality was then assessed by evaluating the incremental change in the hazard ratios after further adjustment for therapy.

ResultsOf 2426 patients, 26% had GFR ≥ 90, 44% had GFR = 60- < 90, 22% had GFR = 30- < 60, and 8% had GFR < 30 ml-min-1.73 m. Greater degrees of renal dysfunction were associated with greater 2-year mortality and lower rates of guideline-based therapy among eligible patients. For patients with severely decreased GFR, adjustment for differences in guideline-based therapy did not significantly attenuate the relationship with mortality HR 3.82, 95% CI 2.39–6.11 partially adjusted; HR = 3.90, 95% CI 2.42–6.28 after adjustment for treatment differences.

ConclusionHigher mortality associated with reduced GFR after AMI is not accounted for by differences in treatment factors, underscoring the need for novel therapies specifically targeting the pathophysiological abnormalities associated with kidney dysfunction to improve survival.

AbbreviationsACE InhibitorsAngiotensin Converting Enzyme Inhibitor

ARBsAngiotensin Receptor Blockers

CABGCoronary Artery Bypass Graft

GFRglomerular filtration rate

MImyocardial infarction

NSTEMINon-ST-elevation myocardial infarction

PCIPercutaneous Coronary Intervention

PREMIERProspective Registry Evaluating Myocardial Infarction: Event and Recovery

STEMIST-elevation myocardial infarction

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2261-9-29 contains supplementary material, which is available to authorized users.

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Autor: Pamela N Peterson - Amrut V Ambardekar - Philip G Jones - Harlan M Krumholz - Erik Schelbert - John A Spertus - John S


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