Comparison of Chronic Kidney Disease and Risk for Presenting With Painless Versus Nonpainless Acute Myocardial Infarction

• Published in: The American journal of cardiology 2012-09, Vol.110 (6), p.790-794
• Main Authors: Lee, Min Goo, MD, Jeong, Myung Ho, MD, Lee, Ki Hong, MD, Park, Keun Ho, MD, Sim, Doo Sun, MD, Yoon, Hyun Ju, MD, Yoon, Nam Sik, MD, Kim, Kye Hun, MD, Kim, Ju Han, MD, Ahn, Youngkeun, MD, Cho, Jeong Gwan, MD, Park, Jong Chun, MD, Kang, Jung Chaee, MD
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Blood pressure; Body mass index; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Confidence intervals; Coronary heart disease; Coronary vessels; Creatinine - blood; Diabetes; Female; Glomerular Filtration Rate; Heart; Heart attacks; Hospitalization; Humans; Ischemia; Kidney diseases; Kidneys; Male; Medical imaging; Medical sciences; Multivariate analysis; Myocardial Infarction - complications; Myocardial Infarction - diagnosis; Myocarditis. Cardiomyopathies; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Pain; Pain - etiology; Renal failure; Renal Insufficiency, Chronic - physiopathology; Retrospective Studies; Risk Assessment; Risk Factors; Urinary system involvement in other diseases. Miscellaneous; Variables
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2012.05.008

Chronic kidney disease increases the risk for developing ischemic heart disease, but it has not been well known whether it also affects the manifestation of painless acute myocardial infarction (AMI), which has important clinical implications. The aim of this study was to identify whether chronic kidney disease is associated with the presentation of painless AMI. A total of 2,656 consecutively hospitalized patients with AMI from January 2008 to February 2012 were enrolled. Estimated glomerular filtration rate (eGFR) was calculated using calibrated serum creatinine and the abbreviated Modification of Diet in Renal Disease (MDRD) equation. Patient clinical characteristics, angiographic findings, and the use of medications were reviewed. Multivariate logistic regression analysis was used to examine the association of reduced eGFR and presentation with painless AMI. A total of 2,176 adults with painful AMI and 480 adults with painless AMI were studied, and baseline eGFR was calculated. Mean eGFR was lower in subjects with painless AMI compared to those with painful AMI. Compared to an eGFR >90 ml/min/1.73 m2 , a strong, graded, independent association was observed between reduced eGFR and presentation with painless AMI, with adjusted odds ratios of 1.65 (95% confidence interval 1.16 to 2.36) for an eGFR of 60 to 89 ml/min/1.73 m2 , 2.92 (95% confidence interval 1.89 to 4.52) for an eGFR of 45 to 59 ml/min/1.73 m2 , and 3.44 (95% confidence interval 2.20 to 5.38) for an eGFR