Suboptimal medical care of patients with ST-Elevation Myocardial Infarction and Renal Insufficiency: results from the Korea acute Myocardial Infarction Registry

Title
Suboptimal medical care of patients with ST-Elevation Myocardial Infarction and Renal Insufficiency: results from the Korea acute Myocardial Infarction Registry
Author(s)
김영조최준석[최준석]마승권[마승권]배은희[배은희]정명호[정명호]김창승[김창승]조명찬[조명찬]김청진[김청진]김수완[김수완]
Keywords
CHRONIC KIDNEY-DISEASE; LEFT-VENTRICULAR FUNCTION; ACUTE CORONARY SYNDROMES; CARDIOVASCULAR OUTCOMES; RISK-FACTORS; MORTALITY; ATHEROSCLEROSIS; REPERFUSION; DYSFUNCTION; INHIBITORS
Issue Date
201209
Publisher
BIOMED CENTRAL LTD
Citation
BMC NEPHROLOGY, v.13
Abstract
Background: The clinical outcomes of ST-segment elevation myocardial infarction (STEMI) are poor in patients with renal insufficiency. This study investigated changes in the likelihood that patients received optimal medical care throughout the entire process of myocardial infarction management, on the basis of their glomerular filtration rate (GFR). Methods: This study analyzed 7,679 patients (age, 63 +/- 13 years; men 73.6%) who had STEMI and were enrolled in the Korea Acute Myocardial Infarction Registry (KAMIR) from November 2005 to August 2008. The study subjects were divided into 5 groups corresponding to strata used to define chronic kidney disease stages. Results: Patients with lower GFR were less likely to present with typical chest pain. The average symptom-to-door time, door-to-balloon time, and symptom-to-balloon time were longer with lower GFR than higher GFR. Primary reperfusion therapy was performed less frequently and the results of reperfusion therapy were poorer in patients with renal insufficiency; these patients were less likely to receive adjunctive medical treatment, such as treatment with aspirin, clopidogrel, beta-blocker, angiotensin-converting enzyme (ACE) inhibitor/angiotensin-receptor blocker (ARB), or statin, during hospitalization and at discharge. Patients who received less intense medical therapy had worse clinical outcomes than those who received more intense medical therapy. Conclusions: Patients with STEMI and renal insufficiency had less chance of receiving optimal medical care throughout the entire process of MI management, which may contribute to worse outcomes in these patients.
URI
http://hdl.handle.net/YU.REPOSITORY/27277http://dx.doi.org/10.1186/1471-2369-13-110
ISSN
1471-2369
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의과대학 > 내과학교실 > Articles
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