Mild-to-moderate kidney dysfunction and the risk of sudden cardiac death in the setting of acute myocardial infarction

BackgroundAlthough end-stage renal disease is known to elevate the risk of sudden cardiac death (SCD), the role of less severe renal impairment in SCD is unclear.ObjectiveThe purpose of this study was to examine the association between mild-to-moderate renal impairment and first ischemic ventricular fibrillation (VF).MethodsRenal function in patients included in the Arrhythmia Genetics in the NEtherlands Study (AGNES) were compared. Cases (n = 337, age 56 ± 1 year, 80% men) were defined as patients who had survived VF at the time of their first acute ST elevation myocardial infarction (STEMI), and controls (n = 339, age 58 ± 1 years, 80% men) were defined as those without VF during their first acute STEMI. Estimated glomerular filtration rate (eGFR) at the time of acute STEMI was computed using the 4-variable Modification of Diet in Renal Disease equation.ResultsAt eGFR less than 105 mL/min, a decrease in eGFR was associated with elevated odds of developing VF during STEMI. The association was essentially flat at eGFR levels >105 mL/min. The lowest eGFR quintile was associated with a >6-fold increase in odds of developing VF compared to the fourth quintile. This association between eGFR and VF at the time of STEMI remained significant after adjusting for potential confounders including electrolyte levels.ConclusionMild-to-moderate kidney dysfunction is associated with a significantly elevated risk of VF in the setting of acute STEMI. Further studies are needed to investigate the precise mechanisms by which mild kidney function results in VF.