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Relation between renal function, presentation, use of therapies and in-hospital complications in acute coronary syndrome: data from the SWEDEHEART register
Huddinge, Sweden.
Danderyd Hospital.
Danderyd Hospital.
Ryhov County Hospital.
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2010 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 268, no 1, 40-49 p.Article in journal (Refereed) Published
Abstract [en]

Szummer K, Lundman P, Jacobson SH, Schon S, Lindback J, Stenestrand U, Wallentin L, Jernberg T, forSWEDEHEART. (Karolinska Institute, Karolinska University Hospital, Stockholm; Karolinska Institute, Danderyd Hospital, Danderyd; Ryhov County Hospital, Jonkoping; University Hospital, Uppsala and University Hospital, Linkoping; Sweden) Relation between renal function, presentation, use of therapies and in-hospital complications in acute coronary syndrome: data from the SWEDEHEART register. J Intern Med 2010; 268: 40-49. Objective. To examine clinical characteristics, presenting symptoms, use of therapy and in-hospital complications in relation to renal function in patients with myocardial infarction(MI). Design. Observational study. Setting. Nationwide coronary care unit registry between 2003-2006 in Sweden. Subjects. Consecutive MI patients with available creatinine( n = 57 477). Results. Glomerular filtration rate was estimated with the Modification of Diet in Renal Disease Study formula. With declining renal function patients were older, had more co-morbidities and more often used cardio-protective medication on admission. Compared to patients with normal renal function, fewer with renal failure presented with chest pain (90% vs. 67%, P less than 0.001), Killip I (89% vs. 58%, P less than 0.001) and ST-elevation myocardial infarction (STEMI) (41% vs. 22%, P less than 0.001). In a logistic regression model lower renal function was independently associated with a less frequent use of anticoagulant and revascularization in non-ST-elevation MI. The likelihood of receiving reperfusion therapy for STEMI was similar in patients with normal-to-moderate renal dysfunction, but decreased in severe renal dysfunction or renal failure. Reperfusion therapy shifted from primary percutaneous coronary intervention in 71% of patients with normal renal function to fibrinolysis in 58% of those with renal failure. Renal function was associated with a higher rate of complications and an exponential increase in in-hospital mortality from 2.5% to 24.2% across the renal function groups. Conclusion. Renal insufficiency influences the presentation and reduces the likelihood of receiving treatment according to current guidelines. Short-term prognosis remains poor.

Place, publisher, year, edition, pages
Blackwell Publishing Ltd , 2010. Vol. 268, no 1, 40-49 p.
Keyword [en]
in-hospital; kidney; myocardial infarction; prognosis; therapies
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-58369DOI: 10.1111/j.1365-2796.2009.02204.xISI: 000278620400007OAI: diva2:343317
Available from: 2010-08-13 Created: 2010-08-11 Last updated: 2010-08-13

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Stenestrand, Ulf
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Cardiology Faculty of Health SciencesDepartment of Cardiology
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