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Prognostic value of silent myocardial infarction in patients with chronic kidney disease being evaluated for kidney transplantation
Patients with advanced chronic kidney disease (CKD) have increased risk of myocardial infarction (MI). Silent MIs (SMIs) are common in CKD patients and carry increased mortality risk. The prevalence and prognostic value of SMI in advanced CKD has not been evaluated. We identified consecutive patient...
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| Published in: | International journal of cardiology 2017-12, Vol.249, p.377-382 |
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| container_end_page | 382 |
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| container_start_page | 377 |
| container_title | International journal of cardiology |
| container_volume | 249 |
| creator | Farag, Ayman A. AlJaroudi, Wael Neill, John Doppalapudi, Harish Kumar, Vineeta Rizk, Dana Iskandrian, Ami E. Hage, Fadi G. |
| description | Patients with advanced chronic kidney disease (CKD) have increased risk of myocardial infarction (MI). Silent MIs (SMIs) are common in CKD patients and carry increased mortality risk. The prevalence and prognostic value of SMI in advanced CKD has not been evaluated.
We identified consecutive patients with advanced CKD who were evaluated for renal transplantation at the University of Alabama at Birmingham between June 2004 and January 2006. Clinical MI (CMI) was determined by review of medical records. SMI was defined as ECG evidence of MI without clinical history of MI. The primary end-point was a composite of death, MI, or coronary revascularization censored at time of renal transplantation.
The cohort included 1007 patients with advanced CKD aged 48±12years (58% men, 43% diabetes, 75% on dialysis). The prevalence of SMI and CMI was 10.7% and 6.7%, respectively. The only independent predictor of SMI was older age (odds ratio for age ≥50yrs. 2.32, p |
| doi_str_mv | 10.1016/j.ijcard.2017.09.175 |
| format | article |
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We identified consecutive patients with advanced CKD who were evaluated for renal transplantation at the University of Alabama at Birmingham between June 2004 and January 2006. Clinical MI (CMI) was determined by review of medical records. SMI was defined as ECG evidence of MI without clinical history of MI. The primary end-point was a composite of death, MI, or coronary revascularization censored at time of renal transplantation.
The cohort included 1007 patients with advanced CKD aged 48±12years (58% men, 43% diabetes, 75% on dialysis). The prevalence of SMI and CMI was 10.7% and 6.7%, respectively. The only independent predictor of SMI was older age (odds ratio for age ≥50yrs. 2.32, p<0.001). During a median follow-up of 28months, 376 (37%) patients experienced the primary outcome (33% death, 2% MI, 5% coronary revascularization). In a multivariable adjusted Cox-regression model, both SMI (adjusted HR 1.58, [1.13–2.20], p=0.007) and CMI (adjusted HR 1.67 [1.15–2.43], p=0.007) were independently associated with the primary outcome. Further, both SMI (HR 2.37 [1.15–4.88], p=0.02) and CMI (HR 4.02 [1.80–8.98], p=0.001) were associated with increased risk after renal transplantation.
SMI is more common than CMI in patients with advanced CKD. Both SMI and CMI are associated with increased risk of future cardiovascular events.</description><identifier>ISSN: 0167-5273</identifier><identifier>EISSN: 1874-1754</identifier><identifier>DOI: 10.1016/j.ijcard.2017.09.175</identifier><identifier>PMID: 28958755</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Adult ; Clinical ; Cohort Studies ; Electrocardiography - trends ; End-stage renal disease ; Female ; Follow-Up Studies ; Humans ; Kidney Transplantation - mortality ; Kidney Transplantation - trends ; Male ; Middle Aged ; Mortality - trends ; Myocardial infarction ; Myocardial Infarction - diagnosis ; Myocardial Infarction - mortality ; Myocardial Infarction - physiopathology ; Prognosis ; Prospective Studies ; Renal Insufficiency, Chronic - diagnosis ; Renal Insufficiency, Chronic - mortality ; Renal Insufficiency, Chronic - physiopathology ; Silent ; Unrecognized</subject><ispartof>International journal of cardiology, 2017-12, Vol.249, p.377-382</ispartof><rights>2017</rights><rights>Published by Elsevier B.V.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c362t-d82d157ec04a450b4eed1951329c9f88e117292156e491d30587caafd1d97efb3</citedby><cites>FETCH-LOGICAL-c362t-d82d157ec04a450b4eed1951329c9f88e117292156e491d30587caafd1d97efb3</cites><orcidid>0000-0002-6877-2811 ; 0000-0002-4271-463X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28958755$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Farag, Ayman A.</creatorcontrib><creatorcontrib>AlJaroudi, Wael</creatorcontrib><creatorcontrib>Neill, John</creatorcontrib><creatorcontrib>Doppalapudi, Harish</creatorcontrib><creatorcontrib>Kumar, Vineeta</creatorcontrib><creatorcontrib>Rizk, Dana</creatorcontrib><creatorcontrib>Iskandrian, Ami E.</creatorcontrib><creatorcontrib>Hage, Fadi G.</creatorcontrib><title>Prognostic value of silent myocardial infarction in patients with chronic kidney disease being evaluated for kidney transplantation</title><title>International journal of cardiology</title><addtitle>Int J Cardiol</addtitle><description>Patients with advanced chronic kidney disease (CKD) have increased risk of myocardial infarction (MI). Silent MIs (SMIs) are common in CKD patients and carry increased mortality risk. The prevalence and prognostic value of SMI in advanced CKD has not been evaluated.
We identified consecutive patients with advanced CKD who were evaluated for renal transplantation at the University of Alabama at Birmingham between June 2004 and January 2006. Clinical MI (CMI) was determined by review of medical records. SMI was defined as ECG evidence of MI without clinical history of MI. The primary end-point was a composite of death, MI, or coronary revascularization censored at time of renal transplantation.
The cohort included 1007 patients with advanced CKD aged 48±12years (58% men, 43% diabetes, 75% on dialysis). The prevalence of SMI and CMI was 10.7% and 6.7%, respectively. The only independent predictor of SMI was older age (odds ratio for age ≥50yrs. 2.32, p<0.001). During a median follow-up of 28months, 376 (37%) patients experienced the primary outcome (33% death, 2% MI, 5% coronary revascularization). In a multivariable adjusted Cox-regression model, both SMI (adjusted HR 1.58, [1.13–2.20], p=0.007) and CMI (adjusted HR 1.67 [1.15–2.43], p=0.007) were independently associated with the primary outcome. Further, both SMI (HR 2.37 [1.15–4.88], p=0.02) and CMI (HR 4.02 [1.80–8.98], p=0.001) were associated with increased risk after renal transplantation.
SMI is more common than CMI in patients with advanced CKD. Both SMI and CMI are associated with increased risk of future cardiovascular events.</description><subject>Adult</subject><subject>Clinical</subject><subject>Cohort Studies</subject><subject>Electrocardiography - trends</subject><subject>End-stage renal disease</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Kidney Transplantation - mortality</subject><subject>Kidney Transplantation - trends</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality - trends</subject><subject>Myocardial infarction</subject><subject>Myocardial Infarction - diagnosis</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Infarction - physiopathology</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Renal Insufficiency, Chronic - diagnosis</subject><subject>Renal Insufficiency, Chronic - mortality</subject><subject>Renal Insufficiency, Chronic - physiopathology</subject><subject>Silent</subject><subject>Unrecognized</subject><issn>0167-5273</issn><issn>1874-1754</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNp9kE2PFCEQhonRuOPqPzCGo5duKRqa5mJiNutHsoke9EwYqN5l7IERmDVz9o9LZ3Y9eqIOz_sW9RDyGlgPDMZ3uz7snM2-5wxUz3QPSj4hG5iU6NoonpJNw1QnuRouyItSdowxofX0nFzwSctJSbkhf77ldBtTqcHRe7sckaaZlrBgrHR_SuuCYBca4myzqyHFNtKDraEBhf4O9Y66u5xii_8MPuKJ-lDQFqRbDPGW4lpqK3o6p_yI1GxjOSw2VrtWviTPZrsUfPXwXpIfH6-_X33ubr5--nL14aZzw8hr5yfuQSp0TFgh2VYgetASBq6dnqcJARTXHOSIQoMfWDvRWTt78FrhvB0uydtz7yGnX0cs1exDcbi0j2A6FgNaSA7jKHRDxRl1OZWScTaHHPY2nwwws-o3O3PWb1b9hmnTnLfYm4cNx-0e_b_Qo-8GvD8D2O68D5hNcU2lQx8yump8Cv_f8BdzfJuS</recordid><startdate>20171215</startdate><enddate>20171215</enddate><creator>Farag, Ayman A.</creator><creator>AlJaroudi, Wael</creator><creator>Neill, John</creator><creator>Doppalapudi, Harish</creator><creator>Kumar, Vineeta</creator><creator>Rizk, Dana</creator><creator>Iskandrian, Ami E.</creator><creator>Hage, Fadi G.</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6877-2811</orcidid><orcidid>https://orcid.org/0000-0002-4271-463X</orcidid></search><sort><creationdate>20171215</creationdate><title>Prognostic value of silent myocardial infarction in patients with chronic kidney disease being evaluated for kidney transplantation</title><author>Farag, Ayman A. ; AlJaroudi, Wael ; Neill, John ; Doppalapudi, Harish ; Kumar, Vineeta ; Rizk, Dana ; Iskandrian, Ami E. ; Hage, Fadi G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c362t-d82d157ec04a450b4eed1951329c9f88e117292156e491d30587caafd1d97efb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Clinical</topic><topic>Cohort Studies</topic><topic>Electrocardiography - trends</topic><topic>End-stage renal disease</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Kidney Transplantation - mortality</topic><topic>Kidney Transplantation - trends</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality - trends</topic><topic>Myocardial infarction</topic><topic>Myocardial Infarction - diagnosis</topic><topic>Myocardial Infarction - mortality</topic><topic>Myocardial Infarction - physiopathology</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Renal Insufficiency, Chronic - diagnosis</topic><topic>Renal Insufficiency, Chronic - mortality</topic><topic>Renal Insufficiency, Chronic - physiopathology</topic><topic>Silent</topic><topic>Unrecognized</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Farag, Ayman A.</creatorcontrib><creatorcontrib>AlJaroudi, Wael</creatorcontrib><creatorcontrib>Neill, John</creatorcontrib><creatorcontrib>Doppalapudi, Harish</creatorcontrib><creatorcontrib>Kumar, Vineeta</creatorcontrib><creatorcontrib>Rizk, Dana</creatorcontrib><creatorcontrib>Iskandrian, Ami E.</creatorcontrib><creatorcontrib>Hage, Fadi G.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Farag, Ayman A.</au><au>AlJaroudi, Wael</au><au>Neill, John</au><au>Doppalapudi, Harish</au><au>Kumar, Vineeta</au><au>Rizk, Dana</au><au>Iskandrian, Ami E.</au><au>Hage, Fadi G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic value of silent myocardial infarction in patients with chronic kidney disease being evaluated for kidney transplantation</atitle><jtitle>International journal of cardiology</jtitle><addtitle>Int J Cardiol</addtitle><date>2017-12-15</date><risdate>2017</risdate><volume>249</volume><spage>377</spage><epage>382</epage><pages>377-382</pages><issn>0167-5273</issn><eissn>1874-1754</eissn><abstract>Patients with advanced chronic kidney disease (CKD) have increased risk of myocardial infarction (MI). Silent MIs (SMIs) are common in CKD patients and carry increased mortality risk. The prevalence and prognostic value of SMI in advanced CKD has not been evaluated.
We identified consecutive patients with advanced CKD who were evaluated for renal transplantation at the University of Alabama at Birmingham between June 2004 and January 2006. Clinical MI (CMI) was determined by review of medical records. SMI was defined as ECG evidence of MI without clinical history of MI. The primary end-point was a composite of death, MI, or coronary revascularization censored at time of renal transplantation.
The cohort included 1007 patients with advanced CKD aged 48±12years (58% men, 43% diabetes, 75% on dialysis). The prevalence of SMI and CMI was 10.7% and 6.7%, respectively. The only independent predictor of SMI was older age (odds ratio for age ≥50yrs. 2.32, p<0.001). During a median follow-up of 28months, 376 (37%) patients experienced the primary outcome (33% death, 2% MI, 5% coronary revascularization). In a multivariable adjusted Cox-regression model, both SMI (adjusted HR 1.58, [1.13–2.20], p=0.007) and CMI (adjusted HR 1.67 [1.15–2.43], p=0.007) were independently associated with the primary outcome. Further, both SMI (HR 2.37 [1.15–4.88], p=0.02) and CMI (HR 4.02 [1.80–8.98], p=0.001) were associated with increased risk after renal transplantation.
SMI is more common than CMI in patients with advanced CKD. Both SMI and CMI are associated with increased risk of future cardiovascular events.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>28958755</pmid><doi>10.1016/j.ijcard.2017.09.175</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-6877-2811</orcidid><orcidid>https://orcid.org/0000-0002-4271-463X</orcidid></addata></record> |
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| ispartof | International journal of cardiology, 2017-12, Vol.249, p.377-382 |
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| source | ScienceDirect Freedom Collection 2022-2024 |
| subjects | Adult Clinical Cohort Studies Electrocardiography - trends End-stage renal disease Female Follow-Up Studies Humans Kidney Transplantation - mortality Kidney Transplantation - trends Male Middle Aged Mortality - trends Myocardial infarction Myocardial Infarction - diagnosis Myocardial Infarction - mortality Myocardial Infarction - physiopathology Prognosis Prospective Studies Renal Insufficiency, Chronic - diagnosis Renal Insufficiency, Chronic - mortality Renal Insufficiency, Chronic - physiopathology Silent Unrecognized |
| title | Prognostic value of silent myocardial infarction in patients with chronic kidney disease being evaluated for kidney transplantation |
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