Community acute kidney injury is associated with short- and long-term adverse outcomes in patients admitted with acute myocardial infarction .

AIMS: The influence of community acute kidney injury on patients with myocardial infarction has not been explored. The Veterans Affair electronic health system was analyzed to test the hypothesis that patients who have myocardial infarction complicated by community acute kidney injury have higher short- and long-term mortality and cardiovascular outcomes than those who do not suffer acute kidney injury.

MATERIALS AND METHODS: Odd ratios were calculated for in-hospital mortality. Cox proportional hazard model was used to assess hazard ratios for long-term mortality comparing patients with and without community acute kidney injury. Secondary outcomes included recurrent cardiovascular events including hospitalization for congestive heart failure, stroke, or repeat myocardial infarction.

RESULTS: 10,689 patients were available for evaluation, 679 had community acute kidney injury and 10,010 with no acute kidney injury. Community acute kidney injury resulted in higher odds for inpatient mortality (odds ratio 5.87, p < 0.001), and adjusted hazard ratio for mortality at 5 years as compared to no acute kidney injury (hazard ratio 1.67, p < 0.001). No differences in cardiovascular outcomes were identified in Cox proportional hazard analysis.

CONCLUSION: In patients with myocardial infarction, community acute kidney injury is associated with delays in or not receiving appropriate myocardial infarction related process of care measures. In addition it is an independent predictor of short- and long-term mortality.
.