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Reduced estimated glomerular filtration rate associated with acute MI
Go A. J Am Coll Cardiol. 2011;58:1600-1607.
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In patients with new onset symptoms of coronary heart disease, a reduced estimated glomerular filtration rate was associated with a greater likelihood of presenting with acute MI vs. stable exertional angina, according to study results.
Patients were enrolled in the study if their first clinical presentation of CHD was acute MI or stable exertional angina between October 2001 and December 2003. Researchers calculated estimated glomerular filtration rate (eGFR) before the incident event with calibrated serum creatinine and the abbreviated Modification of Diet in Renal Disease equation. Self-reports and health plan databases identified patient characteristics and use of medications, and the association of reduced eGFR and CHD presentation was examined by multivariable logistic regression, according to researchers.
They found that patients with acute MI had a lower eGFR mean vs. patients with stable angina. According to study results, there was an association between reduced eGFR and presenting with acute MI, with adjusted OR of 1.36 (95% CI, 0.99-1.86) for eGFR 60 to 89 mL/min/1.73 m2, 1.55 (95% CI, 0.92-2.62) for eGFR 45 to 59 mL/min/1.73 m2, and 3.82 (95% CI, 1.55-9.46) for eGFR less than 45 mL/min/1.73 m2. Self-reported hypertension was reported more in patients with acute MI vs. angina. Patients with acute MI were also more likely to be current or former cigarette smokers and to report minimal or light prior physical leisure-time activity, but less likely to report parental or sibling histories of CHD.
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Chronic kidney disease (CKD) is a recognized risk factor for cardiovascular disease, but it is not clear if the high mortality for CV disease in CKD patients is due to the increased incidence of events or the greater acuity of many of them. Symptoms alone can be unreliable since there is an association between silent (asymptomatic) CAD and ESRD, so more objective criteria are needed. Accordingly, in the present case control study, 803 adults with CKD who had acute MIs as the initial manifestation of CAD were compared with 419 patients with chronic stable angina. A "strong, independent, graded risk was found between reduced estimated GFR and acute MI". Mechanisms that promote plaque instability and inflammation in CKD may explain these findings. Better means to identify the CKD population at risk should be a high priority the authors suggest.
– Peter F. Cohn, MD
Cardiology Today
Editorial Board member
Disclosures: Dr. Cohn reports no relevant financial disclosures.
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