Albuminuria, Reduced Kidney Function, and the Risk of ST‐ and non–ST‐segment–elevation myocardial infarction
Journal Articles
Overview
Research
Identity
Additional Document Info
View All
Overview
abstract
Background
Chronic kidney disease is a recognized independent risk factor for cardiovascular disease, but whether the risks of ST‐segment–elevation myocardial infarction (
STEMI
) and non–ST‐segment–elevation myocardial infarction (
NSTEMI
) differ in the chronic kidney disease population is unknown.
Methods and Results
Using administrative data from Ontario, Canada, we examined patients ≥66 years of age with an outpatient estimated glomerular filtration rate (
eGFR
) and albuminuria measure for incident myocardial infarction from 2002 to 2015. Adjusted Fine and Gray subdistribution hazard models accounting for the competing risk of death were used. In 248 438 patients with 1.2 million person‐years of follow‐up,
STEMI
,
NSTEMI
, and death occurred in 1436 (0.58%), 4431 (1.78%), and 30 015 (12.08%) patients, respectively. The highest level of albumin‐to‐creatinine ratio (>30 mg/mmol) was associated with a 2‐fold higher adjusted risk of both
STEMI
and
NSTEMI
among patients with
eGFR
≥60 mL/(min·1.73 m
2
) compared to albumin‐to‐creatinine ratio <3 mg/mmol. The lowest level of
eGFR
(<30 mL/[min·1.73 m
2
]) was not associated with higher
STEMI
risk but with a 4‐fold higher risk of
NSTEMI
compared to those with
eGFR
≥60 mL/(min·1.73 m
2
). The lowest
eGFR
(<30 mL/[min·1.73 m
2
]) and highest albumin‐to‐creatinine ratio (>30 mg/mmol) were associated with a greater than 4‐fold higher risk of both
STEMI
and
NSTEMI
(subdistribution hazard models [95% confidence interval] 4.53 [3.30‐6.21] and 4.42 [3.67‐5.32], respectively) compared to albumin‐to‐creatinine ratio <3 mg/mmol and
eGFR
≥60 mL/(min·1.73 m
2
).
Conclusions
Elevations in albuminuria are associated with a higher risk of both
NSTEMI
and
STEMI
, regardless of kidney function, whereas reduced kidney function alone is associated with a higher
NSTEMI
risk.
