Low glomerular filtration rate and risk of myocardial infarction: A systematic review and meta-analysis

• Published in: International journal of cardiology 2016-11, Vol.223, p.401-409
• Main Authors: Vashistha, Vishal, M.D, Lee, Meng, M.D, Wu, Yi-Ling, M.D, Kaur, Sukhdeep, M.D, Ovbiagele, Bruce, M.D
• Format: Article
• Language: English
• Subjects: Cardiovascular; Chronic kidney disease; Chronic renal insufficiency; Coronary artery disease; Global Health; Glomerular Filtration Rate - physiology; Humans; Incidence; Myocardial infarction; Myocardial Infarction - epidemiology; Myocardial Infarction - etiology; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - physiopathology; Risk Factors
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2016.07.175

Abstract Background Chronic kidney disease is increasing in prevalence. The association between low baseline estimated glomerular filtration rate (eGFR) and future myocardial infarction has not been comprehensively assessed. Methods A systematic review and meta-analysis of observational studies evaluating the risk for future myocardial infarction associated with eGFR < 60 and 60–90 ml/min/1.73 m2 was completed. Data sources included PubMed, EMBASE, and the Cochrane Library. Included studies were required to have prospectively collected data, followed subjects for at least 6 months, and reported baseline eGFR levels and the multivariate-adjusted relative risk for future myocardial infarction. A random effect model was used and subgroup analyses were conducted. Results 26 publications representing 41 observational cohorts were selected. In total, 1,986,850 participants undergoing more than 35,752 myocardial infarctions (follow-up range: 9 months to ~ 20 years) were evaluated. eGFR < 60 ml/min/1.73 m2 was associated with a relative risk of 1.52 (95% confidence interval 1.39–1.67; p < 0.00001) while eGFR 60–90 ml/min/1.73 m2 was associated with a relative risk of 1.21 (1.09–1.34; p = 0.0002) for myocardial infarction. Significant heterogeneity existed among both eGFR groups. Subgroup analysis found a further increase in risk for myocardial infarction as eGFR declined from 30 to 60 to < 30 ml/min/1.73 m2 (1.40, 95% confidence interval, 1.21–1.61 vs.1.94, 95% confidence interval, 1.51–2.50; p = 0.03). Conclusions Decreased baseline eGFR is independently associated with increased future myocardial infarction, and the risk increases with advanced renal insufficiency. Clinicians should be wary of acute coronary syndromes in patients with CKD.