Prevalence and prognostic impact of renal insufficiency in STEMI from a gender perspective: data from a large prospective cohort
(English)Manuscript (preprint) (Other academic)
Background: Data indicate that female gender may be associated with increased risk of RI in MI but also that presence of RI has higher prognostic impact in women. In case of ST-elevation MI [STEMI], women have higher adjusted mortality compared to men but RI has seldom been taken into account.
Methods and Results: All STEMI patients registered in the Swedish national quality register SWEDEHEART between 2003 and 2009 were included (37991 patients, 66% men). Based on s-creatinine on admission, glomerular filtration rate [GFR] was estimated according to MDRD and Cockcroft-Gault [CG]. RI was defined as eGFR below 60 mL/min. Women had 1.6-2.2 times higher multivariable adjusted risk of RI and half of all women had RI according to CG. RI was associated with 2-2.5 times higher risk of in-hospital and approximately 1.5 times higher risk of long-term mortality in both genders. Each 10 mL/min decline of eGFR was associated with 22-33% and 9-16% increased risk of in-hospital and. long-term mortality, respectively. There was no significant interaction between gender and eGFR regarding outcome. Both in-hospital and long-term mortality was twice as high in women but after adjusting for eGFR according to CG, there was no longer any gender difference in early outcome and long term outcome was better in women.
Conclusions: Among STEMI patients
1) Female sex was independently associated with RI
2) Reduced eGFR regardless of used formula was a strong independent risk factor for mortality without a significant gender difference in prognostic impact.
3) Reduced eGFR (according to CG) appeared to be a main explanatory variable to the higher mortality in women.
Gender differences in prevalence and prognostic impact of renal insufficiency in STEMI Address for correspondence: Sofia Sederholm Lawesson, M.D. Department of Medical and Health Sciences, Division of Cardiovascular Medicine Linköping University SE-581 85 Linköping SWEDEN Telephone: +46 101032169 Fax: +46 101032171 Email: sofia.
Cardiac and Cardiovascular Systems
IdentifiersURN: urn:nbn:se:liu:diva-73915OAI: oai:DiVA.org:liu-73915DiVA: diva2:478623