Trends in the Prevalence of Acute Kidney Injury in Patients with Acute Myocardial Infarction

Comparative Medicine - OneHealth and Comparative Medicine Poster SessionIntroduction: Acute kidney injury (AKI) is common in patients (pts) with acute myocardial infarction (AMI), and associated with permanent renal impairment and death. While guidelines increasingly emphasize the importance of AKI prevention, whether the rates of AKI changed over time is unknown. Methods: We studied 35,425 pts hospitalized with AMI in 66 U.S. centers from 2000-08 using Health Facts, a national database with detailed information on in-hospital renal function. AKI was defined as absolute creatinine increase of ≥ 0.3 mg/dL or relative increase of ≥50%. Temporal trends in AKI during the 9-year study period were evaluated using hierarchical logistic regression, adjusting for secular changes in baseline creatinine and other known AKI predictors. Results: From 2000-08, mean age increased (66.9 vs 68.8 yrs), as did baseline creatinine (1.4 vs 1.5 mg/dL), rate of cardiogenic shock (5.1 vs 6.3%), diabetes (30.4 vs 35.8%), coronary angiography (57 vs 68%), and PCI (30.2 vs 45.2%, P<0.001 for all comparisons). Despite increase in AKI risk factors, the rates of AKI declined steadily (Figure). The trend of decreasing AKI rates persisted after multivariable adjustment (P=0.01). Conclusions: While AKI still affects nearly 1 in 4 AMI pts, the rates of AKI declined significantly from 2000-08, despite the aging population and rising prevalence of AKI risk factors. These findings may reflect the impact of increased clinician awareness, better risk stratification, and AKI prevention efforts during this time period

Risk factors for rehospitalization for acute coronary syndromes and unplanned revascularization following acute myocardial infarction

Background Rehospitalizations for acute coronary syndromes (ACS) and coronary revascularization after an acute myocardial infarction (AMI) are not only common and costly but can also impact patients’ quality of life. In contrast to mortality and all‐cause readmissions, little insight is available into risk factors associated with ACS and revascularization after AMI. Methods and Results In a multicenter AMI registry, we examined the rates and predictors of rehospitalizations for ACS and revascularization within the year after AMI among 3283 patients. Staged revascularization procedures were excluded. Kaplan–Meier estimated rates of rehospitalization due to ACS and revascularization were 6.8% and 4.1%, respectively. In hierarchical, multivariable models, the strongest predictors of rehospitalization for ACS were coronary artery bypass graft prior to AMI hospitalization (hazard ratio [HR] 2.12, 95% CI 1.45 to 3.10), female sex (HR 1.67, 95% CI 1.23 to 2.25), and in‐hospital PCI (HR 1.85, 95% CI 1.28 to 2.69). The strongest predictors of subsequent revascularization were multivessel disease (HR 2.89, 95% CI 1.90 to 4.39) and in‐hospital percutaneous coronary intervention with a bare metal stent (HR 2.08, 95% CI 1.19 to 3.63). The Global Registry of Acute Coronary Events mortality risk score was not associated with the risk of rehospitalization for ACS or revascularization. Conclusions Unique characteristics are associated with admissions for ACS and revascularization, as compared with survival. These multivariable risk predictors may help identify patients at high risk for ACS and revascularization, in whom intensification of secondary prevention therapies or closer post‐AMI follow‐up may be warranted

Health Status Outcomes in Patients With Acute Myocardial Infarction After Rehospitalization

Background Rehospitalizations after acute myocardial infarction for unplanned coronary revascularization and unstable angina (UA) are common. However, despite the inclusion of these events in composite end points of many clinical trials, their association with health status has not been studied. Methods and Results We included 3283 patients with acute myocardial infarction enrolled in a prospective, 24-center US study who had rehospitalizations independently classified by experienced cardiologists. Health status was assessed using Seattle Angina Questionnaire and EuroQol-5D Visual Analog Scale. In the propensity-matched cohorts, 1-year health status was compared between those who did and did not experience rehospitalization for UA or revascularization using a hierarchical linear model. Overall, mean age was 59 years, 33% were women, and 70% were white. Rehospitalization rates for UA and unplanned revascularization at 1 year were 4.3% and 4.7%. One-year Seattle Angina Questionnaire summary scores were worse in patients with rehospitalizations for UA (mean difference, -10.1; 95% confidence interval, -12.4 to -7.9) and unplanned revascularization (mean difference, -5.7; 95% confidence interval, -8.8 to -2.5) when compared with patients without such rehospitalizations. Similarly, EuroQol-5D Visual Analog Scale scores were worse among patients with such readmissions. Individual Seattle Angina Questionnaire domains indicated worse 1-year angina and quality of life outcomes among patients rehospitalized for UA or unplanned revascularization. Conclusions Within the first year after acute myocardial infarction, rehospitalizations for UA and unplanned revascularization are associated with worse health status. These findings highlight the impact of such events from a patient's perspective, beyond their economic impact and support the use of UA and unplanned revascularization as elements of composite end points

Health status outcomes in patients with acute myocardial infarction after rehospitalization

Background Rehospitalizations after acute myocardial infarction for unplanned coronary revascularization and unstable angina (UA) are common. However, despite the inclusion of these events in composite end points of many clinical trials, their association with health status has not been studied. Methods and Results We included 3283 patients with acute myocardial infarction enrolled in a prospective, 24-center US study who had rehospitalizations independently classified by experienced cardiologists. Health status was assessed using Seattle Angina Questionnaire and EuroQol-5D Visual Analog Scale. In the propensity-matched cohorts, 1-year health status was compared between those who did and did not experience rehospitalization for UA or revascularization using a hierarchical linear model. Overall, mean age was 59 years, 33% were women, and 70% were white. Rehospitalization rates for UA and unplanned revascularization at 1 year were 4.3% and 4.7%. One-year Seattle Angina Questionnaire summary scores were worse in patients with rehospitalizations for UA (mean difference, -10.1; 95% confidence interval, -12.4 to -7.9) and unplanned revascularization (mean difference, -5.7; 95% confidence interval, -8.8 to -2.5) when compared with patients without such rehospitalizations. Similarly, EuroQol-5D Visual Analog Scale scores were worse among patients with such readmissions. Individual Seattle Angina Questionnaire domains indicated worse 1-year angina and quality of life outcomes among patients rehospitalized for UA or unplanned revascularization. Conclusions Within the first year after acute myocardial infarction, rehospitalizations for UA and unplanned revascularization are associated with worse health status. These findings highlight the impact of such events from a patient's perspective, beyond their economic impact and support the use of UA and unplanned revascularization as elements of composite end points