Type of myocardial infarction presentation in patients with chronic kidney disease

• NSTEMI is more frequent in patients with CKD (76%) than in those in a CKD stage <3 (24%, p < 0.01) whereas STEMI is similarly frequent in the two groups (45.8 vs. 54.2%).
• Patients with CKD stage ≥3 exhibit more than 4-fold greater probability of ECG-graphic presentation of NSTEMI than patients with stage <3 (OR: 4.28; CI: 1.21–15.10; p = 0.02).
• ECG-graphic presentation of NSTEMI is significantly associated with stage of CKD, independently of CV risk factors and demographics.
• Moderate renal impairment worsens the patient's condition and, therefore, justifies a more aggressive approach to NSTEMI, similar to that used in STEMI.

Background and aimAssociation of coronary and renal disease has been frequently found in epidemiological studies. Whether ECG-graphic presentation of myocardial infarction [S-T Elevated MI (STEMI) or Non S-T Elevated MI (NSTEMI)] is related to the degree of renal dysfunction is still unclear.Methods and resultsWe examined 146 patients with acute myocardial infarction, consecutively entering the Coronary Care Unit of our ward. At entry, patients underwent clinical, ECG-graphic and echocardiographic examination, and blood samples were withdrawn for cardiac markers and general biochemistry. GFR was calculated using the CKD-EPI equation.STEMI was found in 71 cases and NSTEMI in 75 cases. Renal function was normal in 61 patients (stage 1), mildly impaired (<90 mL/min/1.73 m2 and ≥60 mL/min/1.73 m2) in 60 (stage 2) and moderately to severely impaired (GFR <60 mL/min/1.73 m2) in 25 cases (stages 3–4). Patients were, thereafter, clustered into two groups (stages 1–2 and stages 3–4). Compared to stage 1–2 subjects, stages 3–4 patients were older, were more likely to be diabetic and had more frequently previous cardiovascular diseases. The probability of presentation of NSTEMI for stage 3–4 patients was 4-fold greater than for stage 1–2 patients (p = 0.02).ConclusionsThese data support the evidence that 1) NSTEMI is associated with more severe kidney dysfunction, likely due to more severe and/or longer lasting exposition to risk factors; 2) cardiac and renal impairment are strongly associated.ClinicalTrials.gov Identifier: NCT01636427.