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The Influence of Kidney Disease on Outcomes of Patients with Heart Attack FREE

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The summary below is from the full report titled “Acute Myocardial Infarction and Renal Dysfunction: A High-Risk Combination.” It is in the 1 October 2002 issue of Annals of Internal Medicine (volume 137, pages 563-570). The authors are RS Wright, GS Reeder, CA Herzog, RC Albright, BA Williams, DL Dvorak, WL Miller, JG Murphy, SL Kopecky, and AS Jaffe.

Ann Intern Med. 2002;137(7):I-22. doi:10.7326/0003-4819-137-7-200210010-00002
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What is the problem and what is known about it so far?

In a heart attack (acute myocardial infarction), a portion of heart muscle dies because blockages in blood vessels interrupt the blood supply to the heart. Although many people are healthy after a heart attack, some have complications that increase their risk for death. Some even die before leaving the hospital. The presence of other medical conditions can influence recovery after a heart attack. Chronic kidney disease causes kidney function to slowly worsen over time until the kidneys shut down completely, a condition known as end-stage renal disease (ESRD). Patients with ESRD do poorly if they have a heart attack, but doctors have been uncertain about the effect of less severe forms of kidney disease on recovery after a heart attack.

Why did the researchers do this particular study?

To examine survival after heart attack in patients with varying degrees of kidney disease.

Who was studied?

3106 patients hospitalized with heart attack at the Mayo Clinic from 1988 to 2000.

How was the study done?

A nurse collected information from medical charts about kidney disease and other diseases, heart attack treatment, and survival. The researchers placed each patient in one of five groups: ESRD, severe kidney disease, moderate kidney disease, mild kidney disease, or normal kidneys. They then compared the numbers of patients in each group who received accepted heart attack treatments, who survived to leave the hospital, and who left the hospital but died later on. The treatments examined were aspirin, β-blocker medications, and reperfusion therapy (medications or procedures to dissolve clots or bypass the blockages that caused the heart attack).

What did the researchers find?

The proportion of patients who died before leaving the hospital increased from 2% in patients with normal kidneys to 6% in those with mild kidney disease, 14% in those with moderate kidney disease, 21% in those with severe kidney disease, and 30% in those with ESRD. Worsening kidney disease was also related to worse survival during the follow-up period. Patients with poor kidney function were less likely to receive aspirin, β-blockers, and reperfusion therapy.

What were the limitations of the study?

The study involved a single medical center, and the results may not apply to other settings. Because there may have been valid reasons for avoiding certain therapies in patients with kidney disease, this study cannot tell us whether giving such patients more reperfusion therapy, aspirin, and β-blockers would improve their survival after heart attack.

What are the implications of the study?

As the degree of kidney disease increases from none to ESRD, patients have worse survival after heart attack. In addition, patients with kidney disease are less likely to receive effective heart attack treatments.





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