The dose-response association between estimated glomerular filtration rate and prognosis of patients with ST-segment elevation myocardial infarction from rural areas of China's Liaoning province

Abstract

We aimed to investigate the dose-response associations between chronic kidney disease (CKD), and short and long-term cardiovascular outcomes, to characterize these associations by drawing dose-response curves based on a Chinese rural ST-segment elevation myocardial infarction (STEMI) population.In all, 1067 patients with STEMI were consecutively enrolled from 12 secondary hospitals of China's Liaoning province (from June 2009 to June 2010 and January 2015 to December 2015). The follow-up was regularly performed by telephone. Patients were grouped by estimated glomerular filter rate (eGFR): normal, eGFR ≥90 mL/min/1.73 m; mild CKD, 60 to 90 mL/min/1.73 m; CKD, <60 mL/min/1.73 m. Adjusted logistic or Cox regression models were employed to compare short and long-term cardiovascular outcomes across different eGFR groups. Dose-response curves were plotted using restricted cubic spline functions.About 18.46% of the STEMI patients had CKD. Patients with CKD were more likely to suffer from other comorbidities, but less likely to receive evidence-based therapies. CKD was independently associated with in-hospital mortality and major adverse cardiac events (MACE) as compared with patients with normal renal function (for in-hospital mortality, adjusted odds ratio [OR] 2.39, 95% confidence interval [CI] 1.18-4.85, P = .02; for in-hospital MACE, adjusted OR 2.01, 95% CI 1.09-3.70, P < .01). Likewise, CKD was significantly associated with long-term mortality as well (CKD vs normal, adjusted hazard ratio 2.55, 95% CI 1.17-5.57, P = .02). The dose-response associations between eGFR, and short and long-term cardiovascular outcomes were found to be linear (all with P values for nonlinear associations >.05).CKD is an independent predictor of worse in-hospital and long-term clinical outcomes. The assessment of eGFR is essential to enable risk stratification, tailored therapy, and early and aggressive management.

Figure 1

Flowchart showing the process of patients selection.

Figure 2

Kaplan-Meier estimates of the long-term mortality (A) and long-term major adverse cardiac events (B) by admission eGFR category. eGFR = estimated glomerular filtration rate.

Figure 3

Adjusted dose-response association between eGFR and in-hospital mortality (A) and MACE (B). Adjusted factors include age, sex, and other significant covariates in multivariate analyses. Y-axis indicates the Ln(OR) of in-hospital mortality for any value of eGFR compared with individuals with 90 mL/min/1.73 m² of eGFR. Dashed lines refer to 95% confidence intervals. AIC = Akaike information criterion, eGFR = estimated glomerular filtration rate, MACE = major adverse cardiac events, OR = odds ratio.

Figure 4

Adjusted dose-response association between eGFR and long-term mortality (A) and MACE (B). Adjusted factors include age, sex, and other significant covariates in multivariate analyses. Y-axis indicates the ln(HR) of in-hospital mortality for any value of eGFR compared with individuals with 90 mL/min/1.73 m² of eGFR. Dashed lines refer to 95% confidence intervals. AIC = Akaike information criterion, eGFR =estimated glomerular filtration rate, HR =hazard ratio, MACE = major adverse cardiac events.