Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd. Dallas, Dallas, TX 75390-8830, USA.
Duke Clinical Research Institute, Duke University Medical Center, 7022 North Pavilion, Durham, NC 27715, USA.
Eur Heart J Qual Care Clin Outcomes. 2018 Jan 1;4(1):43-50. doi: 10.1093/ehjqcco/qcx020.
To examine the association of acute kidney injury (AKI) with long-term outcomes after myocardial infarction (MI), and evaluate whether effect modification is present according to baseline chronic kidney disease (CKD) status.
ACTION Registry records from 2008 to 2012 were linked to Medicare claims data, creating a cohort of 76 500 acute MI patients aged ≥ 65 years who survived to hospital discharge. Mild, moderate, and severe AKI were defined as changes in creatinine from baseline to peak of 0.3 to < 0.5, 0.5 to < 1.0, and ≥ 1.0 mg/dL, respectively. Stage 3, Stage 4, and Stage 5 CKD were defined as estimated glomerular filtration rates of 30-59, 15-29, and <15 mL/min/m2, respectively. Cox proportional hazards modelling was used to examine associations of AKI with long-term outcomes. The prevalence of baseline CKD was: Stage 3 (41.2%), Stage 4 (6.7%), and Stage 5 (1.0%). The incidence of AKI was: mild (7.5%), moderate (6.0%), and severe (3.0%). A significant interaction of AKI with baseline CKD was observed for 1-year mortality (Pinteraction <0.001). Acute kidney injury was associated with worse multivariable-adjusted 1-year mortality among individuals without CKD: mild AKI [hazard ratio (HR): 1.33, 95% confidence interval (CI): 1.22-1.49], moderate AKI (HR:1.66, 95% CI: 1.46-1.89), and severe AKI (HR: 2.87, 95% CI: 2.41-3.43). An attenuation of this effect was noted with advancing stages of baseline CKD such that among patients with Stage 5 CKD, AKI was not associated with 1-year mortality.
Acute kidney injury is associated with worse long-term outcomes after MI. This effect is modified by baseline CKD status.
探讨急性肾损伤（AKI）与心肌梗死后长期预后的关系，并评估根据基线慢性肾脏病（CKD）状态是否存在效应修饰。
将 2008 年至 2012 年 ACTION 注册研究记录与医疗保险索赔数据相关联，创建了一个年龄≥65 岁、存活至出院的 76500 例急性心肌梗死患者队列。轻度、中度和重度 AKI 定义为基线至峰值时肌酐的变化分别为 0.3 至<0.5、0.5 至<1.0 和≥1.0mg/dL。3 期、4 期和 5 期 CKD 分别定义为估计肾小球滤过率为 30-59、15-29 和<15mL/min/m2。使用 Cox 比例风险模型来检验 AKI 与长期预后的关系。基线 CKD 的患病率为：3 期（41.2%）、4 期（6.7%）和 5 期（1.0%）。AKI 的发生率为：轻度（7.5%）、中度（6.0%）和重度（3.0%）。AKI 与基线 CKD 之间存在显著的交互作用，在 1 年死亡率上（P 交互<0.001）。在无 CKD 的个体中，AKI 与更差的多变量校正 1 年死亡率相关：轻度 AKI [危险比（HR）：1.33，95%置信区间（CI）：1.22-1.49]、中度 AKI（HR：1.66，95%CI：1.46-1.89）和重度 AKI（HR：2.87，95%CI：2.41-3.43）。随着基线 CKD 阶段的进展，这种效应减弱，以至于在 5 期 CKD 患者中，AKI 与 1 年死亡率无关。
急性肾损伤与心肌梗死后的长期预后不良有关。这种效应受基线 CKD 状态的影响。
