1Bremer Institut für Herz- und Kreislaufforschung (BIHKF) Bremen, Deutschland; 2Klinikum Bremen-Mitte Klinik für Innere Medizin III Bremen, Deutschland
Background: Cardiorenal syndromes (CRS), especially in patients with advanced heart failure have been the focus of many recent investigations and clinical studies. However, there is little data on the prevalence and the impact of the combination of heart failure and renal disease in patients admitted with acute myocardial infarctions. Aim of the present study was therefore to analyse prevalence rates and the impact of cardiorenal syndromes in patients admitted with ST-elevation myocardial infarctions (STEMI).
Methods: All patients from a large German PCI-center admitted between 2006 and 2022 with STEMI were included. Cardiorenal disease was defined as a combination of a left-ventricular ejection fraction <40% (heart failure, HF) and a (chronic) kidney disease of at least stage G3a (GFR<60 ml/min , KD). Prevalence rates, cardiovascular risk factors and outcomes were compared in a 2x2 design (HF-/KD-; HF-/KD+, HF+/KD-, HF+/KD+). Outcome analysis was adjusted by confounders in a multivariate model.
Results: Of a total of 8209 STEMI-patients 5736(70%) had a preserved LV-EF and no CKD (HF-/KD-), 1291 (16%) a preserved LV-EF and CKD (HF-/KD+), 742 (9%) a reduced LV-EF and no CKD (HF+/KD-) and 440 (5%) both a reduced LV-EF and CKD (HF+/KD+, CRS-Group). Patients with CRS were on average older (74.5±12 yrs. vs. 60.9±13 yrs. ,p<0.01), were more likely to be female (38.2% vs. 23.1%, p<0.01) and more likely to be diabetics (30.8% vs. 16.7%, p<0.01). Furthermore, the rate of cardiogenic shock (CS) in CRS-patients was higher (41.% vs. 8.8%, p<0.01). Unadjusted data showed, that CRS-patients had a marked increase in risk for developing advanced acute kidney failure (AKIN-stage 3 (KDIGO) with or w/o need for renal replacement therapy (RRT)): HR 17.9, p<0.01, as well as a higher in-hospital (HR 22.5, p<0.01) and 1-year-mortality-rates (HR 13.3, p<0.01). Rates of adverse-events for patients with either only heart failure or renal disease were in between the control-group and the CRS-patient group (table). When adjusting outcomes for confounders (age, gender, cardiogenic shock, diabetes, anterior STEMI, 3 VD, interventional result) the detrimental effect of CRS remained evident: AKIN-3/RRT: OR 16.5, 95% CI 7.5-30.0, p<0.01; In-hospital-mortality: OR 14.2, 95% CI 7.8-21, p<0.01, 1-year-mortality: OR 10.5, 95% CI 7.5-14.1, p<0.01.
Table: Adverse event rates in patients stratified by LV-EF and presence of renal disease
| Group | HF-/KD- | HF-/KD+ | HF+/KD- | HF+/KD+ | P (for trend) |
| Criteria | LV-EF≥40% and no CKD | LV-EF≥40% and CKD G3a or higher | LV-EF<40% and no CKD | LV-EF<40% and CKD G3a or higher | - |
| AKIN 3 with or w/o RRT (%) | 0.9 | 8.9 | 5.6 | 16.8 | <0.01 |
| In-hospital mortality (%) | 1.5 | 10.4 | 9.5 | 33.1 | <0.01 |
| 1-year-mortality (%) | 4.9 | 23.0 | 23.6 | 59.1 | <0.01 |
Conclusions: In this analysis of registry data, cardiorenal disease could be detected in 5% of STEMI-patients, with higher rates in the elderly, in women and in diabetics. Patients with cardiorenal disease showed a 18x higher risk of suffering severe renal failure during the index event and a 23x higher risk of in-hospital death. These results underline the detrimental effect of the combination of heart failure and renal disease in patients with acute myocardial infarctions.