Clinical Significance of Chronic Kidney Disease and Atrial Fibrillation on Morbidity and Mortality in Patients with Acute Myocardial Infarction

Abstract

Background/Aims: Atrial fibrillation (AF) often coexists with acute myocardial infarction (AMI), and chronic kidney disease (CKD) is a major risk for AMI. However, the combined impact of CKD and AF on the mortality and morbidity in AMI population has not been determined. Methods: Between January 2004 and December 2009, a total of 4,738 AMI patients were enrolled prospectively. Patients were divided into four groups according to the combined status of CKD and AF. The primary endpoint was a combination of 5-year major adverse cardiac and cerebrovascular events (MACCE). Results: The prevalence of AF was significantly higher in CKD patients than in non-CKD patients (6.76 vs. 3.31%, p < 0.001). The highest cumulative event rate of MACCE and death was observed in patients with both CKD and AF (68.5 and 64.0%), respectively. In multivariable analyses, compared with patients with neither AF nor CKD, hazard ratios (HR) for composite of MACCE were 1.66 (95% CI, 1.14-2.41), 1.24 (95% CI, 1.06-1.46), and 2.10 (95% CI, 1.42-3.13) for patients with AF only, those with CKD only, and those with both CKD and AF, respectively (p for interaction = 0.935). Patients with both CKD and AF had a greatest risk for all-cause mortality (HR 2.54; 95% CI, 1.60-4.53), and the significant synergistic interaction was observed between CKD and AF (p for interaction = 0.015). Conclusion: The combined effect of AF and CKD on the risk of MACCE after an AMI is stronger than any separate condition, and it confers a synergistic effect on the all-cause mortality risk.

Association between impaired renal function and stroke outcome in patients with versus without atrial fibrillation

“…Several studies showed that CKD was associated with an increased risk of stroke or systemic thromboembolism amongst patients with AF [5,6,18,19]. Combined CKD and AF were also reported to be associated with an increased risk of mortality in patients with myocardial infarction [20]. A previous study from China including 229 patients with ischaemic stroke (admitted within 1 month of stroke onset) and AF showed that reduced eGFR was independently associated with increased risk of death but not stroke recurrence [13].…”

Anticoagulation for Stroke Prevention in Older Adults with Atrial Fibrillation and Comorbidity: Current Evidence and Treatment Challenges

“…In patients with both AF and CKD there is a 35% increase in relative risk of death 40) and more than a 2-fold increase in major cardiovascular adverse effects. 41) …”

A Review of the Relationship of Atrial Fibrillation and Acute Coronary Syndrome

“…Characteristics that were repeatedly more common in those who developed NAF included female gender [27, 41, 45, 50, 51]), higher Killip Class [27, 52–54], lower LVEF [27, 50–54], diabetes mellitus [27, 50, 55], hypertension, [56, 57], and lower renal function [50, 52, 54–57]. Parashar et al found that diabetes was less common in those who developed NAF [57].…”