Chronic Kidney Disease and Health Status Outcomes Following Acute Myocardial Infarction

Abstract

Background: The association between chronic kidney disease (CKD) and health status outcomes after acute myocardial infarction (AMI) is unknown.

Methods and results: Patients were enrolled between 2005 and 2008 in the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status (TRIUMPH) registry, a prospective multicenter observational study of AMI outcomes. The Seattle Angina Questionnaire and Short Form-12 were collected at baseline and at 1, 6, and 12 months following AMI. CKD was defined by an estimated glomerular filtration rate <60 mL/min, calculated during the AMI hospitalization. Linear repeated-measures models assessed the association between CKD and health status after AMI, accounting for the propensity to have follow-up heath status measures. Of 3617 patients, 576 (16%) had CKD and 3041 (84%) did not have CKD. Patients with CKD were older and had more comorbidity. Patients with CKD were more likely to have multivessel coronary disease and less likely to undergo revascularization. Among AMI survivors, patients with and without CKD had similar health-related quality of life (adjusted difference of 0.24, 95% CI -1.46 to 1.95), angina frequency (adjusted difference of 1.27, 95% CI -0.05 to 2.58), and mental health (adjusted difference of -0.07, 95% CI -0.90 to 0.75). In contrast, patients with CKD had lower physical health (adjusted difference -1.61, 95% CI -2.49 to -0.74), which was not clinically significant, compared with patients without CKD.

Conclusions: Among AMI survivors, patients with CKD not only had more comorbidities but also, after adjusting for these patient differences, had similar health status compared with patients without CKD. Interventions aimed at improving health status after AMI should not focus on CKD status.

Keywords: acute myocardial infarction; chronic kidney disease; health status; outcomes research; registry.