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European Heart Journal Advance Access originally published online on April 23, 2009
European Heart Journal 2009 30(12):1486-1494; doi:10.1093/eurheartj/ehp132
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Renal and cardiac function for long-term (10 year) risk stratification after myocardial infarction

Suetonia C. Palmer1, Timothy G. Yandle1, Christopher M. Frampton1, Richard W. Troughton1,2, M. Gary Nicholls1 and A. Mark Richards1,2,*

1 Department of Medicine, University of Otago Christchurch, 2 Riccarton Avenue, PO Box 4345, Christchurch 8140, New Zealand
2 Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand

Received 28 November 2008; revised 17 February 2009; accepted 12 March 2009; online publish-ahead-of-print 23 April 2009.

* Corresponding author. Tel: +64 3 364 1116, Fax: +64 3 364 1115, Email: mark.richards{at}cdhb.govt.nz

Aims: To determine whether combined renal and cardiac function after acute myocardial infarction (MI) predicts 10 year mortality and heart failure (HF).

Methods and results: Estimated glomerular filtration rate (eGFR), plasma amino terminal pro-brain natriuretic peptide (NT-proBNP), and radionuclide ventriculography were obtained in 1063 patients with MI between 24–96 h of symptom onset. Mortality and HF were documented over follow-up of 9.3 years. Estimated GFR, NT-proBNP, and left ventricular ejection fraction (LVEF) each independently predicted 10 year mortality. Reduced eGFR (below 60 mL/min/1.73 m2) combined with increased NT-proBNP (above 1000 pg/mL) was associated with higher mortality rate compared with preserved eGFR together with lower NT-proBNP (60 vs. 14%, P < 0.001). Similar results for mortality were identified for eGFR combined with LVEF (dichotomized about 50%) (58 vs. 17%, P < 0.001). Corresponding analysis combining eGFR and NT-proBNP to predict HF yielded rates of 34 and 7% for high- and low-risk groups, respectively (P < 0.001). Similar risk stratification for HF was observed when combining eGFR with LVEF (35 vs. 7%, P < 0.001).

Conclusion: Ten year rates of mortality and HF are 5–10 times higher when lower eGFR is present together with increased NT-proBNP or depressed LVEF.

Key Words: Myocardial infarction • Kidney function • Mortality • Heart failure • Hospitalisation


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