Is AKI Worse Than a Heart Attack?
Is AKI Worse Than a Heart Attack?
In all, 36,980 patients had sufficient serum creatinine levels measured during their hospitalization to characterize the outcomes. Of those, 18,921 patients had MI only, 8426 had AKI only, and 9633 had both.
The group with MI only was demographically similar to the group who had both MI and AKI, with a few key exceptions. The group with both events was slightly older and included more patients with diabetes. The group who experienced AKI only included more black persons than those with MI only or those with both. With respect to comorbidities, the group experiencing AKI only were more similar to those experiencing both MI and AKI in that they had a greater proportion of patients with diabetes and hypertension than those who had MI alone.
Not unexpectedly, the group experiencing both MI and AKI had the worst outcomes in univariate analysis. Their risk for death, MACE, MAKE, and MARCE was highest. Of importance, the incremental risks of "adding" AKI to a hospitalization for MI were significant. The risk for death was 32.2% among those with MI alone, but 57.5% among those with both MI and AKI. A similarly greater risk for MACE, MAKE, and MARCE was also seen among patients with both MI and AKI compared with those with MI only. Of interest, the incremental risk of "adding" MI to patients hospitalized with AKI was not as dramatic, although risk for death was above 50% in both groups (53.1% for those with AKI, but 57.5% for those with both).
The important and surprising finding is that patients with AKI had significantly worse outcomes than patients with MI alone. In multivariable analyses that controlled for baseline eGFR; sex; race; age; serum albumin; and the presence of diabetes, hypertension, coronary artery disease, or stroke at baseline, these relative relationships of risk remained unchanged. Compared with those with MI alone, patients with AKI alone had a greater risk for death (hazard ratio [HR], 1.85), MAKE (HR, 2.07), and MARCE (HR, 1.37).
Study Results
In all, 36,980 patients had sufficient serum creatinine levels measured during their hospitalization to characterize the outcomes. Of those, 18,921 patients had MI only, 8426 had AKI only, and 9633 had both.
The group with MI only was demographically similar to the group who had both MI and AKI, with a few key exceptions. The group with both events was slightly older and included more patients with diabetes. The group who experienced AKI only included more black persons than those with MI only or those with both. With respect to comorbidities, the group experiencing AKI only were more similar to those experiencing both MI and AKI in that they had a greater proportion of patients with diabetes and hypertension than those who had MI alone.
Not unexpectedly, the group experiencing both MI and AKI had the worst outcomes in univariate analysis. Their risk for death, MACE, MAKE, and MARCE was highest. Of importance, the incremental risks of "adding" AKI to a hospitalization for MI were significant. The risk for death was 32.2% among those with MI alone, but 57.5% among those with both MI and AKI. A similarly greater risk for MACE, MAKE, and MARCE was also seen among patients with both MI and AKI compared with those with MI only. Of interest, the incremental risk of "adding" MI to patients hospitalized with AKI was not as dramatic, although risk for death was above 50% in both groups (53.1% for those with AKI, but 57.5% for those with both).
The important and surprising finding is that patients with AKI had significantly worse outcomes than patients with MI alone. In multivariable analyses that controlled for baseline eGFR; sex; race; age; serum albumin; and the presence of diabetes, hypertension, coronary artery disease, or stroke at baseline, these relative relationships of risk remained unchanged. Compared with those with MI alone, patients with AKI alone had a greater risk for death (hazard ratio [HR], 1.85), MAKE (HR, 2.07), and MARCE (HR, 1.37).
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