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Data indicate that in the case of myocardial infarction (MI) the prevalence and prognostic impact of renal insufficiency (RI) are higher in women. In the case of ST-elevation MI (STEMI), women have a higher adjusted mortality compared to men but RI has seldom been taken into account.
All STEMI patients registered in the Swedish national quality register SWEDEHEART 2003-2009 were included, 37991 patients. Based on s-creatinine on admission, the glomerular filtration rate was estimated (eGFR) according to the MDRD and Cockcroft-Gault (CG) formulas. Follow up was maximum 8 years (median 1152 days).
Women had 1.6 and 2.2 times higher multivariable adjusted risk of RI (eGFR <60 mL/min), depending on if MDRD or CG was used. Half of all women had RI according to CG, 38% according to MDRD. Corresponding numbers for men were 22 and 19%. RI was associated with 2–2.5 times higher risk of in-hospital mortality and approximately 1.5 times higher risk of long-term mortality in both genders. Each 10 mL/min decline of eGFR was associated with a 22–33% increased risk of in-hospital mortality and 9–16% increased risk of long term mortality (numbers depending on used formula). There was no significant interaction between sex and eGFR regarding short or long term mortality. Both in-hospital and long term mortality were twice as high in women. After multivariable adjustments including all confounders except kidney function women had still 11% higher risk of in-hospital mortality whereas men had 7% higher risk of long term mortality. If eGFR according to any of the formulas was also included, there was no longer a gender difference regarding in-hospital mortality and women had a lower risk of long term mortality. Adjusting for eGFR according to CG alone was enough to eradicate the higher risk in women, both short and long term.
Among STEMI patients
1) Female sex was independently associated with RI
2) Reduced eGFR regardless of the formula used was a strong independent risk factor for mortality without a significant gender difference in prognostic impact.
3) Reduced eGFR appeared to be an important reason as to why women had twice as high mortality compared to men with STEMI.
West, Room 3020
Saturday, March 09, 2013, 8:30 a.m.-8:45 a.m.
Session Title: ACS: Vulnerable and Underrepresented Populations
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 902-5
- 2013 American College of Cardiology Foundation