Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Department of Internal Medicine, Kent Memorial Hospital and Warren Alpert Medical School of Brown University, Warwick, Rhode Island.
Am J Cardiol. 2022 Feb 15;165:1-11. doi: 10.1016/j.amjcard.2021.10.041. Epub 2021 Dec 7.
Very few studies evaluated the impact of acute kidney injury (AKI) and chronic kidney disease (CKD) on heart failure (HF) hospitalization risk following an acute myocardial infarction (AMI). For this retrospective cohort analysis, we identified adult AMI survivors from January to June 2014 from the United States Nationwide Readmissions Database. Outcomes were a 6-month HF, fatal HF, composite of HF during the AMI or a 6-month HF, and a composite of 6-month HF or death during a non-HF-related admission. We analyzed differences in outcomes across categories of patients without renal injury, AKI without CKD, stable CKD, AKI on CKD, and end-stage renal disease (ESRD). Of 237,549 AMI survivors, AKI was present in 13.8%, CKD in 16.5%, ESRD in 3.4%, and AKI on CKD in 7.7%. Patients with renal failure had lower coronary revascularization rates and higher in-hospital HF. A 6-month HF hospitalization occurred in 12,934 patients (5.4%). Compared with patients without renal failure (3.3%), 6-month HF admission rate was higher in patients with AKI on CKD (14.6%; odds ratio [OR] 1.99; 95% confidence interval [CI] 1.81 to 2.19), ESRD (11.2%; OR 1.57; 95% CI 1.36 to 1.81), stable CKD (10.7%; OR 1.72; 95% CI 1.56 to 1.88), and AKI (8.6%; OR 1.52; 95% CI 1.36 to 1.70). Results were generally homogenous in prespecified subgroups and for the other outcomes. In conclusion, 1 in 4 AMI survivors had either acute or chronic renal failure. The presence of any form of renal failure was associated with a substantially increased risk of 6-month HF hospitalizations and associated mortality with the highest risk associated with AKI on CKD.
很少有研究评估急性肾损伤（AKI）和慢性肾脏病（CKD）对急性心肌梗死（AMI）后心力衰竭（HF）住院风险的影响。在这项回顾性队列分析中，我们从 2014 年 1 月至 6 月从美国全国再入院数据库中确定了 AMI 幸存者的成年患者。结果是 6 个月 HF、致命性 HF、AMI 期间的 HF 或 6 个月 HF 的复合以及非 HF 相关入院期间的 6 个月 HF 或死亡的复合。我们分析了无肾损伤、无 CKD 的 AKI、稳定 CKD、CKD 上的 AKI 和终末期肾病（ESRD）患者在各分类中结局的差异。在 237549 例 AMI 幸存者中，AKI 发生率为 13.8%，CKD 发生率为 16.5%，ESRD 发生率为 3.4%，CKD 上的 AKI 发生率为 7.7%。有肾功能衰竭的患者冠状动脉血运重建率较低，院内 HF 发生率较高。12934 例患者发生 6 个月 HF 住院（5.4%）。与无肾功能衰竭的患者（3.3%）相比，CKD 上 AKI 患者的 6 个月 HF 入院率更高（14.6%；比值比[OR]1.99；95%置信区间[CI]1.81 至 2.19）、ESRD（11.2%；OR 1.57；95% CI 1.36 至 1.81）、稳定 CKD（10.7%；OR 1.72；95% CI 1.56 至 1.88）和 AKI（8.6%；OR 1.52；95% CI 1.36 至 1.70）。在预先指定的亚组和其他结果中，结果基本一致。总之，1/4 的 AMI 幸存者有急性或慢性肾衰竭。任何形式的肾功能衰竭都与 6 个月 HF 住院和相关死亡率的风险显著增加有关，而 CKD 上 AKI 的风险最高。
