Tags

Type your tag names separated by a space and hit enter

Underuse of standard care and outcome of patients with acute myocardial infarction and chronic renal insufficiency.
Cardiology. 2007; 108(3):193-9.C

Abstract

OBJECTIVES

To investigate characteristics, management and outcome of patients with acute myocardial infarction (AMI) and chronic renal insufficiency (CRI).

BACKGROUND

Patients with AMI and CRI are considered to be at high risk of complications and death. Physicians may be reluctant to prescribe life-saving medications to patients with concomitant CRI.

METHODS

We compared clinical characteristics, management and outcome of 1,683 consecutive AMI patients in three categories of renal function: (1) normal renal function (<1.5 mg/dl) (n = 1,559), (2) mild to moderate CRI (1.5-3.5 mg/dl) (n = 77), and (3) severe CRI (>3.5 mg/dl) (n = 47).

RESULTS

CRI patients were older and were more likely to have other co-morbidities such as hypertension, diabetes mellitus, prior AMI, stroke, angina and heart failure. Compared with patients with normal renal function, standard therapy for AMI including thrombolysis, aspirin, angiotensin-converting-enzyme inhibitors, beta-blockers and lipid lowering agents was underutilized in CRI patients and these patients were more likely to have in-hospital complications such as heart failure, atrial or ventricular fibrillation, cardiogenic shock, sepsis, worsening of renal function and death within 30 days [odds ratio (OR) = 3.3; 95% confidence interval (CI) = 2.0-4.8]. After adjustment for age and co-morbidities, the association between mild to moderate CRI and 30-days mortality declined, whereas severe CRI remained an independent determinant of mortality (OR = 4.8; 95% CI = 2.0-11.4). Adjustment for aspirin, angiotensin-converting-enzyme inhibitors and beta-blocker therapy weakened the association between CRI and death within 30 days after AMI.

CONCLUSIONS

CRI patients are more likely to experience serious complications and death early after AMI. Underutilization of standard care, particularly beta-blocker therapy, contributes to increased mortality risk in these patients.

Authors+Show Affiliations

Neufeld Cardiac Research Institute, Tel-Aviv University, Tel-Hashomer, Israel.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17095865

Citation

Tessone, Ariel, et al. "Underuse of Standard Care and Outcome of Patients With Acute Myocardial Infarction and Chronic Renal Insufficiency." Cardiology, vol. 108, no. 3, 2007, pp. 193-9.
Tessone A, Gottlieb S, Barbash IM, et al. Underuse of standard care and outcome of patients with acute myocardial infarction and chronic renal insufficiency. Cardiology. 2007;108(3):193-9.
Tessone, A., Gottlieb, S., Barbash, I. M., Garty, M., Porath, A., Tenenbaum, A., Hod, H., Boyko, V., Mandelzweig, L., Behar, S., & Leor, J. (2007). Underuse of standard care and outcome of patients with acute myocardial infarction and chronic renal insufficiency. Cardiology, 108(3), 193-9.
Tessone A, et al. Underuse of Standard Care and Outcome of Patients With Acute Myocardial Infarction and Chronic Renal Insufficiency. Cardiology. 2007;108(3):193-9. PubMed PMID: 17095865.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Underuse of standard care and outcome of patients with acute myocardial infarction and chronic renal insufficiency. AU - Tessone,Ariel, AU - Gottlieb,Shmuel, AU - Barbash,Israel M, AU - Garty,Moshe, AU - Porath,Avi, AU - Tenenbaum,Alexander, AU - Hod,Hanoch, AU - Boyko,Valentina, AU - Mandelzweig,Lori, AU - Behar,Solomon, AU - Leor,Jonathan, Y1 - 2006/11/07/ PY - 2005/07/21/received PY - 2006/07/28/accepted PY - 2006/11/11/pubmed PY - 2007/10/27/medline PY - 2006/11/11/entrez SP - 193 EP - 9 JF - Cardiology JO - Cardiology VL - 108 IS - 3 N2 - OBJECTIVES: To investigate characteristics, management and outcome of patients with acute myocardial infarction (AMI) and chronic renal insufficiency (CRI). BACKGROUND: Patients with AMI and CRI are considered to be at high risk of complications and death. Physicians may be reluctant to prescribe life-saving medications to patients with concomitant CRI. METHODS: We compared clinical characteristics, management and outcome of 1,683 consecutive AMI patients in three categories of renal function: (1) normal renal function (<1.5 mg/dl) (n = 1,559), (2) mild to moderate CRI (1.5-3.5 mg/dl) (n = 77), and (3) severe CRI (>3.5 mg/dl) (n = 47). RESULTS: CRI patients were older and were more likely to have other co-morbidities such as hypertension, diabetes mellitus, prior AMI, stroke, angina and heart failure. Compared with patients with normal renal function, standard therapy for AMI including thrombolysis, aspirin, angiotensin-converting-enzyme inhibitors, beta-blockers and lipid lowering agents was underutilized in CRI patients and these patients were more likely to have in-hospital complications such as heart failure, atrial or ventricular fibrillation, cardiogenic shock, sepsis, worsening of renal function and death within 30 days [odds ratio (OR) = 3.3; 95% confidence interval (CI) = 2.0-4.8]. After adjustment for age and co-morbidities, the association between mild to moderate CRI and 30-days mortality declined, whereas severe CRI remained an independent determinant of mortality (OR = 4.8; 95% CI = 2.0-11.4). Adjustment for aspirin, angiotensin-converting-enzyme inhibitors and beta-blocker therapy weakened the association between CRI and death within 30 days after AMI. CONCLUSIONS: CRI patients are more likely to experience serious complications and death early after AMI. Underutilization of standard care, particularly beta-blocker therapy, contributes to increased mortality risk in these patients. SN - 1421-9751 UR - https://www.unboundmedicine.com/medline/citation/17095865/Underuse_of_standard_care_and_outcome_of_patients_with_acute_myocardial_infarction_and_chronic_renal_insufficiency_ L2 - https://www.karger.com?DOI=10.1159/000096777 DB - PRIME DP - Unbound Medicine ER -