0
Sign In  | Subscribe
1 October 2002, Vol 137, No. 7>
Summaries for Patients | 1 October 2002

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

[+] Article and Author Information

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
Text Size: A A A

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.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general jounals
BMJ 2010;341:c5893-c1494.

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy This Article

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Register Now for a free account
Advertisement

Related Content

Customize your page view by dragging & repositioning the boxes below.

Topic Collections
PubMed Articles
Prognostic value of B-type natriuretic peptide and its amino-terminal proBNP fragment for cardiovascular events with stratification by renal function.
Journal of cardiology Issue date: 2013 Apr 22
The effect of vitamin D status on risk factors for cardiovascular disease.
Nature reviews. Nephrology Issue date: 2013 Apr 23

Annals of Internal Medicine

Other Resources

Copyright © 2013 The American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704

Buy This Article

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Register Now for a free account
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)