Benefits of aspirin and beta-blockade after myocardial infarction in patients with chronic kidney disease

Abstract

Background: There have been no randomized trials of cardioprotective therapy after acute myocardial infarction in patients with chronic kidney disease who should be largely eligible for aspirin (acetylsalicylic acid; ASA) and beta-blockers (BB) as a base of therapy.

Methods: We analyzed a prospective coronary care unit registry of 1724 patients with ST-segment elevation myocardial infarction.

Results: Usage rates were 52.3%, 19.0%, 15.2%, and 13.5% for ASA and BB (ASA+BB), BB alone, ASA alone, and no ASA or BB therapy. Patients who received ASA+BB were more likely to be male, free of earlier cardiac disease, and recipients of thrombolysis. Conversely, the absence of ASA+BB was observed in patients with heart failure on admission, left bundle branch block, atrial and ventricular arrhythmias, and shock. The combination of ASA+BB was used in 63.9%, 55.8%, 48.2%, and 35.5% of patients with corrected creatinine clearance values of >81.5, 81.5 to 63.1, 63.1 to 46.2, and <46.2 mL/min/72 kg (P <.0001). ASA+BB was used in 40.4% of patients undergoing dialysis. The age-adjusted relative risk reduction for the inhospital mortality rate was similar among all renal groups and ranged from 64.3% to 80.0% (all P <.0001).

Conclusion: ASA+BB is an underused therapy in patients with acute myocardial infarction who have underlying kidney disease.