AKI Is Associated With Worse Outcomes After a Heart Attack

Patients with acute kidney injury (AKI) have a greater risk of mortality within 1 year after myocardial infarction (MI), according to a recent study. However, this risk is likely lessened in patients who had had chronic kidney disease (CKD) prior to MI.

After linking ACTION Registry records from 2008 to 2012 with Medicare claims data, the researchers assessed a cohort of 76,500 patients with an acute MI who were aged 65 years or younger and had survived hospital discharge.
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Patients were classified as having mild, moderate, or severe AKI based on changes in creatinine level from baseline to peak. Additionally, stages 3, 4, or 5 CKD were categorized based on estimated glomerular filtration rates.

Associations between AKI and long-term outcomes were evaluated via Cox proportional hazards. The researchers indicated that a total of 7.5% of patients had mild AKI, 6.0% had moderate AKI, and 3.0% had severe AKI.

Additionally, 41.2% of patients were classified as having stage 3 CKD at baseline, while 6.7% had stage 4 CKD, and 1.0% had stage 5 CKD.

Results indicated that AKI was associated with worse multivariable-adjusted 1-year mortality among individuals without CKD. This effect attenuated along more advanced stages of CKD at baseline, meaning that AKI was not associated with 1-year mortality in patients with stage 5 CKD.

“AKI is associated with worse long-term outcomes after MI. This effect is modified by baseline CKD status,” the researchers concluded.

—Christina Vogt

Reference:

Mody P, Wang T, McNamara R, et al. Association of acute kidney injury and chronic kidney disease with processes of care and long-term outcomes in patients with acute myocardial infarction [Published online June 27, 2017]. Eur Heart J Qual Care Clin Outcomes. doi:10.1093/ehjqcco/qcx020.