Copyright © 2002 by the European Society of Cardiology.
The prognostic importance of creatinine clearance after acute myocardial infarction
a Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
b Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
c Department of Cardiology, Amager University Hospital, Copenhagen, Denmark
revised September 5, 2001; accepted September 6, 2001
Abstract
Aims The purpose of this study was to assess renal dysfunction as an independent predictor of mortality after acute myocardial infarction.
Methods The study population was 6252 patients with a myocardial infarction admitted alive from 1990 to 1992. The mortality status was obtained after at least 6 years.
Results Cox proportional-hazards model demonstrated that the unadjusted risk ratio associated with a calculated creatinine clearance 
40ml.min–1 compared to a clearance above 85ml.min–1 was 7·1 (95% confidence interval 6·2–8·0). Adjustment for multiple available covariates reduced this risk to 2·0 (1·6–2·4). The unadjusted risk ratio associated with clearance from 41 to 55ml.min–1 and from 71 to 85ml.min–1 was 3·7 (3·3–4·2) and 1·5 (1·3–1·7) respectively, but after adjustment for all available variables these risks were reduced to 1·4 (1·2–1·6) and 1·1 (0·9–1·3) respectively.
Conclusion Renal dysfunction is an important risk factor after acute myocardial infarction. When the risk is adjusted for available competing risk factors only severely reduced renal function is associated with an important and independent risk of mortality after acute myocardial infarction. The risk of a moderate reduction in renal function is almost fully explained by an association with other conditions.
Key Words: Renal dysfunction, impairment, prognosis, acute myocardial infarction
f1 Correspondence: Dr Christian Torp-Pedersen, Department of Cardiology, Gentofte University Hospital, 2900 Hellerup, Denmark.
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