Declining renal function after myocardial infarction predicts poorer long-term outcome.

INTRODUCTION: In-hospital decline in renal function during the immediate post myocardial infarction (MI) period is known to predict poorer outcome; subsequent chronic change in renal function is less well reported. This study sought to track long-term change in renal function after MI, and assess its correlation with the outcome.

METHODS AND RESULTS: Individuals who had sustained a first validated MI in the preceding 2.5-11.5 years were identified from the monitoring of trends and determinants in cardiovascular disease (MONICA) register and were invited to undergo a screening process in 1995, and again in 1998. All deaths were recorded up to the end of 2006. Change in renal function between 1995 and 1998 was available for 500 individuals (mean age 61.6+/-7.3 years, 74.8% men). Change in (Delta) calculated estimated glomerular filtration rate (eGFR) was normally distributed, with a mean crude fall in eGFR of 1.91+/-9.47 ml/min per 1.73 m. This corresponded to a -1.9+/-13.3% change in eGFR, or -0.8+/-3.6 ml/min/1.73 m2 per year. Delta eGFR correlated negatively with baseline eGFR (r=l-0.307, P<0.001). The first tertile (with the largest decline in eGFR) had an adjusted hazard ratios of 1.86 (1.14-3.03) for all cause mortality and 2.06 (1.13-3.74) for cardiovascular death, compared to the third tertile. A rise in creatinine of greater than 0.3 mg/dl carried adjusted hazard ratios of 2.27 (1.13-4.57) and 3.61 (1.73-7.54) for all cause mortality and cardiovascular death, respectively.

CONCLUSION: Chronic change in renal function after MI is predictive of long-term prognosis.