학술논문
Impact of Chronic Kidney Disease on In-Hospital and 3-Year Clinical Outcomes in Patients With Acute Myocardial Infarction Treated by Contemporary Percutaneous Coronary Intervention and Optimal Medical Therapy ― Insights From the J-MINUET Study ―
Document Type
Journal Article
Author
Atsunori Okamura; Atsushi Hirohata; Hideo Izawa; Hiroshi Funayama; Hiroshi Takahashi; Hisao Ogawa; Junya Ako; Kazuo Kimura; Kazuoki Dai; Kazuteru Fujimoto; Keijiro Saku; Ken Kozuma; Kengo Tanabe; Kenichi Tsujita; Koichi Nakao; Kunihiro Nishimura; Mafumi Owa; Masaharu Ishihara; Minoru Wake; Nobuaki Kokubu; Satoru Suwa; Satoshi Yasuda; Shigeru Oshima; Shino Kan; Shiro Uemura; Takashi Morita; Takashi Muramatsu; Teruo Inoue; Teruo Noguchi; Tetsuya Tobaru; Tevfik F Ismail; Toshiaki Mano; Wataru Shimizu; Yasuhiro Morita; Yoshihiko Miyamoto; Yoshihiko Saito; Yoshisato Shibata; Yousuke Hashimoto; Yukio Ozaki; on behalf of J-MINUET Investigators
Source
Circulation Journal. 2021, 85(10):1710
Subject
Language
English
ISSN
1346-9843
1347-4820
1347-4820
Abstract
Methods and Results:A total of 3,281 patients with AMI were enrolled in the J-MINUET registry, with primary PCI of 93.1% in STEMI. CKD stage on admission was classified into: no CKD (eGFR ≥60 mL/min/1.73 m2); moderate CKD (60>eGFR≥30 mL/min/1.73 m2); and severe CKD (eGFR <30 mL/min/1.73 m2). While the primary endpoint was all-cause mortality, the secondary endpoint was major adverse cardiac events (MACE), defined as a composite of all-cause death, cardiac failure, myocardial infarction (MI) and stroke. Of the 3,281 patients, 1,878 had no CKD, 1,073 had moderate CKD and 330 had severe CKD. Pre-person-days age- and sex-adjusted in-hospital mortality significantly increased from 0.014% in no CKD through 0.042% in moderate CKD to 0.084% in severe CKD (P<0.0001). Three-year mortality and MACE significantly deteriorated from 5.09% and 15.8% in no CKD through 16.3% and 38.2% in moderate CKD to 36.7% and 57.9% in severe CKD, respectively (P<0.0001). C-index significantly increased from the basic model of 0.815 (0.788–0.841) to 0.831 (0.806–0.857), as well as 0.731 (0.708–0.755) to 0.740 (0.717–0.764) when adding CKD stage to the basic model in predicting 3-year mortality (P=0.013; net reclassification improvement [NRI] 0.486, P<0.0001) and MACE (P=0.046; NRI 0.331, P<0.0001) respectively.