Short-term Outcomes of Acute Myocardial Infarction in Patients with Acute Kidney Injury: A Report from the National Cardiovascular Data Registry

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Background -

Acute kidney injury (AKI) is a risk factor for long-term adverse outcomes including acute myocardial infarction (MI) and death. However, the relationship between severity of AKI and in-hospital outcomes in the setting of acute MI has not been well-documented.

Methods and Results -

The study population (n=59,970) was drawn from the ACTION Registry®-GWTG(tm), a nation-wide sample of MI patients admitted to 383 hospitals in the United States between July 2008 and September, 2009. AKI was defined using absolute changes in serum creatinine (SCr; peak SCr – admission SCr), and categorized as no AKI (SCr change<0.3 mg/dl), mild AKI (SCr change 0.3-<0.5 mg/dl), moderate AKI (SCr change 0.5-<1.0 mg/dl), and severe AKI (SCr change 1.0 mg/dl). Overall, 16.1% had AKI, including 6.5% with mild AKI, 5.6% with moderate AKI, and 4.0% with severe AKI. In-hospital mortality rates for those with mild, moderate and severe AKI were 6.6%, 14.2%, and 31.8% compared to 2.1% without AKI. The odds ratio for in-hospital death were 2.4 (95% CI 2.0-2.7), 4.5 (95% CI 3.9-5.1), and 12.6 (95% CI 11.1-14.3) for mild, moderate, and severe AKI compared to those without AKI. Although patients with AKI were less likely to undergo early invasive care or to receive antiplatelet therapies, rates of major bleeding ranged from 8.4% (no AKI) to 32.7% (severe AKI).

Conclusions -

AKI is common and associated with mortality and bleeding, underscoring the importance of efforts to identify risk factors and prevent AKI in AMI care.

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