Document Detail


Chronic kidney disease and risk for presenting with acute myocardial infarction versus stable exertional angina in adults with coronary heart disease.
MedLine Citation:
PMID:  21958887     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The aim of this study was to examine whether kidney dysfunction is associated with the type of clinical presentation of coronary heart disease (CHD).
BACKGROUND: Reduced kidney function increases the risk for developing CHD, but it is not known whether it also influences the acuity of clinical presentation, which has important prognostic implications.
METHODS: A case-control study was conducted of subjects whose first clinical presentation of CHD was either acute myocardial infarction or stable exertional angina between October 2001 and December 2003. Estimated glomerular filtration rate (eGFR) before the incident event was calculated using calibrated serum creatinine and the abbreviated MDRD (Modification of Diet in Renal Disease) equation. Patient characteristics and use of medications were ascertained from self-report and health plan databases. Multivariable logistic regression was used to examine the association of reduced eGFR and CHD presentation.
RESULTS: A total of 803 adults with incident acute myocardial infarctions and 419 adults with incident stable exertional angina who had baseline eGFRs ≤130 ml/min/1.73 m(2) were studied. Mean eGFR was lower in subjects with acute myocardial infarctions compared with those with stable angina. Compared with eGFR of 90 to 130 ml/min/1.73 m(2), a strong, graded, independent association was found between reduced eGFR and presenting with acute myocardial infarction, with adjusted odds ratios of 1.36 (95% confidence interval: 0.99 to 1.86) for eGFR 60 to 89 ml/min/1.73 m(2), 1.55 (95% confidence interval: 0.92 to 2.62) for eGFR 45 to 59 ml/min/1.73 m(2), and 3.82 (95% confidence interval: 1.55 to 9.46) for eGFR <45 ml/min/1.73 m(2) (p < 0.001 for trend).
CONCLUSIONS: An eGFR <45 ml/min/1.73 m(2) is a strong, independent predictor of presenting with acute myocardial infarction versus stable angina as the initial manifestation of CHD.
Authors:
Alan S Go; Nisha Bansal; Malini Chandra; Phenius V Lathon; Stephen P Fortmann; Carlos Iribarren; Chi-Yuan Hsu; Mark A Hlatky;
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  58     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-09-30     Completed Date:  2012-01-05     Revised Date:  2014-04-29    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1600-7     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angina, Stable / epidemiology*,  physiopathology
Case-Control Studies
Chronic Disease
Coronary Disease / epidemiology*,  physiopathology
Female
Glomerular Filtration Rate
Humans
Kidney Diseases / epidemiology*,  physiopathology
Logistic Models
Male
Middle Aged
Myocardial Infarction / epidemiology*,  physiopathology
Predictive Value of Tests
Risk Factors
Grant Support
ID/Acronym/Agency:
K23 DK088865/DK/NIDDK NIH HHS; K24 DK092291/DK/NIDDK NIH HHS; U01 DK060902/DK/NIDDK NIH HHS; U01 DK060902-12/DK/NIDDK NIH HHS; U19 HL091179/HL/NHLBI NIH HHS; U19 HL091179-05/HL/NHLBI NIH HHS
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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