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Observational Study
. 2015 Jun 23;5(6):e008188.
doi: 10.1136/bmjopen-2015-008188.

Prevalence and prognostic impact of chronic kidney disease in STEMI from a gender perspective: data from the SWEDEHEART register, a large Swedish prospective cohort

Sofia Sederholm Lawesson  1 , Joakim Alfredsson  1 , Karolina Szummer  2 , Mats Fredrikson  3 , Eva Swahn  1
Affiliations
Observational Study

Prevalence and prognostic impact of chronic kidney disease in STEMI from a gender perspective: data from the SWEDEHEART register, a large Swedish prospective cohort

Sofia Sederholm Lawesson et al. BMJ Open. .

Abstract

Objectives: Gender differences in prevalence and prognostic impact of chronic kidney disease (CKD) in ST segment elevation myocardial infarction (STEMI) have been poorly evaluated. In STEMI, female gender has been independently associated with an increased risk of mortality. CKD has been found to be an important prognostic marker in myocardial infarction. The aim of this study was to evaluate gender differences in prevalence and prognostic impact of CKD on short-term and long-term mortality.

Design: Prospective observational cohort study.

Setting: The national quality register SWEDEHEART was used. In the beginning of the study period, 94% of the Swedish coronary care units contributed data to the register, which subsequently increased to 100%. The glomerular filtration rate was estimated (eGFR) according to Modification of Diet in Renal Disease Study (MDRD) and Cockcroft-Gault (CG).

Participants: All patients with STEMI registered in SWEDEHEART from the years 2003-2009 were included (37,991 patients, 66% men).

Main results: Women had 1.6 (MDRD) to 2.2 (CG) times higher multivariable adjusted risk of CKD. Half of the women had CKD according to CG. CKD was associated with 2-2.5 times higher risk of in-hospital mortality and approximately 1.5 times higher risk of long-term mortality in both genders. Each 10 mL/min decline of eGFR was associated with an increased risk of in-hospital and long-term mortality (22-33% and 9-16%, respectively) and this did not vary significantly by gender. Both in-hospital and long-term mortality were doubled in women. After multivariable adjustment including eGFR, there was no longer any gender difference in early outcome and the long-term outcome was better in women.

Conclusions: Among patients with STEMI, female gender was independently associated with CKD. Reduced eGFR was a strong independent risk factor for short-term and long-term mortality without a significant gender difference in prognostic impact and seems to be an important reason why women have higher mortality than men with STEMI.

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Figures

Figure 1
Figure 1
Chronic kidney disease (CKD) stages according to Modification of Diet in Renal Disease Study (MDRD) (left) and Cockcroft-Gault (CG) (right) in five age-groups.
Figure 2
Figure 2
Kaplan-Meier survival curves per chronic kidney disease (CKD) stages, women and men. Comparisons between CKD groups, Wilcoxon (Gehan) Statistics, p<0.001 for all comparisons except between CKD 4 and 5 in men (p=0.40 and 0.30, Modification of Diet in Renal Disease Study (MDRD) and Cockcroft-Gault (CG), respectively).
Figure 3
Figure 3
Logistic and Cox proportional hazard regression models of in-hospital and long-term mortality. OR and HR with 95% CIs, women versus men (CG, Cockcroft-Gault; eGFR, estimated glomerular filtration rate; MDRD, Modification of Diet in Renal Disease Study).
See this image and copyright information in PMC

References

    1. Anavekar NS, McMurray JJ, Velazquez EJ et al. . Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med 2004;351:1285–95. 10.1056/NEJMoa041365 - DOI - PubMed
    1. Santopinto JJ, Fox KA, Goldberg RJ et al. . Creatinine clearance and adverse hospital outcomes in patients with acute coronary syndromes: findings from the global registry of acute coronary events (GRACE). Heart 2003;89:1003–8. 10.1136/heart.89.9.1003 - DOI - PMC - PubMed
    1. Gibson CM, Dumaine RL, Gelfand EV et al. . Association of glomerular filtration rate on presentation with subsequent mortality in non-ST-segment elevation acute coronary syndrome; observations in 13,307 patients in five TIMI trials. Eur Heart J 2004;25:1998–2005. 10.1016/j.ehj.2004.08.016 - DOI - PubMed
    1. Sadeghi HM, Stone GW, Grines CL et al. . Impact of renal insufficiency in patients undergoing primary angioplasty for acute myocardial infarction. Circulation 2003;108:2769–75. 10.1161/01.CIR.0000103623.63687.21 - DOI - PubMed
    1. Al Suwaidi J, Reddan DN, Williams K et al. . Prognostic implications of abnormalities in renal function in patients with acute coronary syndromes. Circulation 2002;106:974–80. 10.1161/01.CIR.0000027560.41358.B3 - DOI - PubMed

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