Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 3, Number 3, June 2012, pages 123-132

Renal Dysfunction was an Independent Predictor of In-Hospital Death and Ventricular Rupture in Patients With Acute Myocardial Infarction

**Table 1.** Coronary Angiographical Findings and Therapeutic Interventions (%)
n	in-hospital death	survivors	P
^* 70% of which were repairs for ventricular rupture.
coronary angiography	87.2	98.8	< 0.0001
no significant stenosis	1.3	1.7	0.801
one vessel disease	28.2	61.6	< 0.0001
two vessel disease	24.4	21.7	0.582
three vessel disease	15.4	8.6	0.046
left main coronary disease	17.9	5.2	< 0.0001
percutaneous coronary intervention	62.8	85.5	< 0.0001
intra-aortic balloon pumping	59.0	16.3	< 0.0001
percutaneous cardiopulmonary support	9.0	0.6	< 0.0001
extracorporeal ultrafiltration method	2.6	0.1	< 0.0001
temporary pacing	23.1	5.7	< 0.0001
implantable cardioverter-defibrillator	0.0	0.7	0.450
coronary artery bypass graft	11.5	9.6	0.589
other heart surgery^*	12.8	2.1	< 0.0001

Table 1. Coronary Angiographical Findings and Therapeutic Interventions (%)

in-hospital death

survivors

964

^* 70% of which were repairs for ventricular rupture.

coronary angiography

87.2

98.8

< 0.0001

no significant stenosis

1.3

1.7

0.801

one vessel disease

28.2

61.6

< 0.0001

two vessel disease

24.4

21.7

0.582

three vessel disease

15.4

8.6

0.046

left main coronary disease

17.9

5.2

< 0.0001

percutaneous coronary intervention

62.8

85.5

< 0.0001

intra-aortic balloon pumping

59.0

16.3

< 0.0001

percutaneous cardiopulmonary support

9.0

0.6

< 0.0001

extracorporeal ultrafiltration method

2.6

0.1

< 0.0001

temporary pacing

23.1

5.7

< 0.0001

implantable cardioverter-defibrillator

0.0

0.7

0.450

coronary artery bypass graft

11.5

9.6

0.589

other heart surgery^*

12.8

2.1

< 0.0001

**Table2.** Candidate Predictors of in-Hospital Death
n	in-hospital death	survivors	P
Mean ± SD or %, ^* in 835 patients whose ejection fraction was measured.
age (years)	77.2 ± 10.1	68.1 ± 12.5	< 0.0001
BMI (kg/m²)	22.3 ± 3.2	23.4 ± 3.3	0.005
female sex	42.3	27.8	0.007
renal dysfunction	79.5	32.3	< 0.0001
obesity	20.5	29.5	0.093
diabetes	29.5	25.8	0.479
hypertension	57.7	63.1	0.345
hypercholesterolemia	14.1	40.1	< 0.0001
current smoking	32.1	43.0	0.059
family history of AMI	5.1	10.1	0.157
angina pectoris	17.9	15.6	0.577
valvular heart disease	7.7	3.1	0.033
chronic heart failure	7.7	2.8	0.018
atrial fibrillation	10.3	6.7	0.242
hemorrhagic stroke	2.6	2.0	0.720
ischemic stroke	21.8	12.3	0.017
peripheral artery disease	6.4	4.4	0.168
aortic aneurysm	0.0	2.4	0.401
malignant diseases	5.1	7.0	0.539
others miscellaneous diseases	44.9	31.0	0.012
ventricular rupture	24.4	0.8	< 0.0001
ejection fraction (%)^*	33.5 ± 12.0	49.6 ± 10.6	< 0.0001

Table2. Candidate Predictors of in-Hospital Death

in-hospital death

survivors

964

Mean ± SD or %, ^* in 835 patients whose ejection fraction was measured.

age (years)

77.2 ± 10.1

68.1 ± 12.5

< 0.0001

BMI (kg/m²)

22.3 ± 3.2

23.4 ± 3.3

0.005

female sex

42.3

27.8

0.007

renal dysfunction

79.5

32.3

< 0.0001

obesity

20.5

29.5

0.093

diabetes

29.5

25.8

0.479

hypertension

57.7

63.1

0.345

hypercholesterolemia

14.1

40.1

< 0.0001

current smoking

32.1

43.0

0.059

family history of AMI

5.1

10.1

0.157

angina pectoris

17.9

15.6

0.577

valvular heart disease

7.7

3.1

0.033

chronic heart failure

7.7

2.8

0.018

atrial fibrillation

10.3

6.7

0.242

hemorrhagic stroke

2.6

2.0

0.720

ischemic stroke

21.8

12.3

0.017

peripheral artery disease

6.4

4.4

0.168

aortic aneurysm

0.0

2.4

0.401

malignant diseases

5.1

7.0

0.539

others miscellaneous diseases

44.9

31.0

0.012

ventricular rupture

24.4

0.8

< 0.0001

ejection fraction (%)^*

33.5 ± 12.0

49.6 ± 10.6

< 0.0001

**Table 3.** Multivariable Odds Ratios^* of in-Hospital Death Apart From the Disease Severity
independent predictor	odds ratio	95% confidence interval	P
^* The final stage odds ratios of stepwise multivariable logistic regressions using age, female sex, obesity, diabetes, hypertension, hypercholesterolemia, renal dysfunction, current smoking, family history of myocardial infarction, angina pectoris, chronic heart failure, valvular heart disease, atrial fibrillation, hemorrhagic stroke, ischemic stroke, peripheral artery disease, aortic aneurysm, malignant disease, and other miscellaneous diseases as initial independent variables.
in all subjects (n = 1,042)
age (years)	1.04	1.01 - 1.06	0.0069
renal dysfunction	5.75	3.12 - 10.59	< 0.0001
hypercholesterolemia	0.34	0.17 - 0.67	0.0017
in subjects younger than 75 years (n = 647)
female sex	2.70	1.09 - 6.66	0.032
renal dysfunction	12.63	5.06 - 31.53	< 0.0001
hypercholesterolemia	0.25	0.09 - 0.70	0.008
hypertension	0.38	0.16 - 0.87	0.021
in subjects younger than 69 years (n = 452)
renal dysfunction	13.62	3.91 - 47.46	< 0.0001
hypertension	0.25	0.08 - 0.84	0.025

Table 3. Multivariable Odds Ratios^* of in-Hospital Death Apart From the Disease Severity

independent predictor

odds ratio

95% confidence interval

^* The final stage odds ratios of stepwise multivariable logistic regressions using age, female sex, obesity, diabetes, hypertension, hypercholesterolemia, renal dysfunction, current smoking, family history of myocardial infarction, angina pectoris, chronic heart failure, valvular heart disease, atrial fibrillation, hemorrhagic stroke, ischemic stroke, peripheral artery disease, aortic aneurysm, malignant disease, and other miscellaneous diseases as initial independent variables.

in all subjects (n = 1,042)

age (years)

1.04

1.01 - 1.06

0.0069

renal dysfunction

5.75

3.12 - 10.59

< 0.0001

hypercholesterolemia

0.34

0.17 - 0.67

0.0017

in subjects younger than 75 years (n = 647)

female sex

2.70

1.09 - 6.66

0.032

renal dysfunction

12.63

5.06 - 31.53

< 0.0001

hypercholesterolemia

0.25

0.09 - 0.70

0.008

hypertension

0.38

0.16 - 0.87

0.021

in subjects younger than 69 years (n = 452)

renal dysfunction

13.62

3.91 - 47.46

< 0.0001

hypertension

0.25

0.08 - 0.84

0.025

**Table 4.** Multivariable Odds Ratios of in-Hospital Death for Various Degrees of Renal Dysfunction
renal dysfunction	odds ratio^*	95% confidence interval	P
^* compared with eGFR ≥ 60 mL/min/1.73m², ^# estimated glomerular filtration rate.
eGFR^# < 15 mL/min/1.73m² (n = 23)	4.00	0.84 - 19.09	0.082
eGFR 15 - 29.9 mL/min/1.73m² (n = 38)	20.40	7.81 - 53.31	< 0.0001
eGFR < 30 mL/min/1.73m² (n = 61)	14.81	6.19 - 35.40	< 0.0001
eGFR 30 - 59.9 mL/min/1.73m² (n = 320)	4.98	2.54 - 9.78	< 0.0001

Table 4. Multivariable Odds Ratios of in-Hospital Death for Various Degrees of Renal Dysfunction

renal dysfunction

odds ratio^*

95% confidence interval

^* compared with eGFR ≥ 60 mL/min/1.73m², ^# estimated glomerular filtration rate.

eGFR^# < 15 mL/min/1.73m² (n = 23)

4.00

0.84 - 19.09

0.082

eGFR 15 - 29.9 mL/min/1.73m² (n = 38)

20.40

7.81 - 53.31

< 0.0001

eGFR < 30 mL/min/1.73m² (n = 61)

14.81

6.19 - 35.40

< 0.0001

eGFR 30 - 59.9 mL/min/1.73m² (n = 320)

4.98

2.54 - 9.78

< 0.0001

**Table 5.** Multivariable Odds Ratios of in-Hospital Death Including the Disease Severity in Predictors
independent predictor	odds ratio	95% confidence interval	P
The initial independent variables: ^* those of Table 3 plus ventricular rupture, ^# those of ^* plus one vessel disease, two vessel disease, three vessel disease, left main coronary artery disease, and percutaneous coronary intervention, ^$ those of ^# plus ejection fraction.
including ventricular rupture in independent variables in all subjects (n = 1,042)^*
age (years)	1.04	1.00 - 1.07	0.028
renal dysfunction	5.80	3.01 - 11.16	< 0.0001
ventricular rupture	35.64	13.04 - 97.45	< 0.0001
hypercholesterolemia	0.26	0.12 - 0.56	0.0006
current smoking	1.73	0.94 - 3.18	0.078
other miscellaneous diseases	1.62	0.94 - 2.77	0.082
in subjects who underwent coronary angiography (n = 1,020)^#
age (years)	1.04	1.01 - 1.08	0.015
renal dysfunction	4.67	2.36 - 9.24	< 0.0001
ventricular rupture	37.69	13.81 - 102.88	< 0.0001
hypercholesterolemia	0.24	0.11 - 0.55	0.0006
left main coronary artery disease	2.55	1.16 - 5.61	0.020
one vessel disease	0.35	0.18 - 0.66	0.001
current smoking	2.08	1.09 - 3.99	0.027
chronic heart failure	2.50	0.90 - 6.95	0.078
in subjects whose ejection fraction was measured (n = 835)^$
renal dysfunction	6.65	2.67 - 16.60	< 0.0001
ventricular rupture	6.93	1.22 - 39.48	0.029
ejection fraction (%)	0.88	0.85 - 0.92	< 0.0001
left main coronary artery disease	2.93	1.00 - 8.54	0.050
hypercholesterolemia	0.44	0.17 - 1.14	0.091

Table 5. Multivariable Odds Ratios of in-Hospital Death Including the Disease Severity in Predictors

independent predictor

odds ratio

95% confidence interval

The initial independent variables: ^* those of Table 3 plus ventricular rupture, ^# those of ^* plus one vessel disease, two vessel disease, three vessel disease, left main coronary artery disease, and percutaneous coronary intervention, ^$ those of ^# plus ejection fraction.

including ventricular rupture in independent variables in all subjects (n = 1,042)^*

age (years)

1.04

1.00 - 1.07

0.028

renal dysfunction

5.80

3.01 - 11.16

< 0.0001

ventricular rupture

35.64

13.04 - 97.45

< 0.0001

hypercholesterolemia

0.26

0.12 - 0.56

0.0006

current smoking

1.73

0.94 - 3.18

0.078

other miscellaneous diseases

1.62

0.94 - 2.77

0.082

in subjects who underwent coronary angiography (n = 1,020)^#

age (years)

1.04

1.01 - 1.08

0.015

renal dysfunction

4.67

2.36 - 9.24

< 0.0001

ventricular rupture

37.69

13.81 - 102.88

< 0.0001

hypercholesterolemia

0.24

0.11 - 0.55

0.0006

left main coronary artery disease

2.55

1.16 - 5.61

0.020

one vessel disease

0.35

0.18 - 0.66

0.001

current smoking

2.08

1.09 - 3.99

0.027

chronic heart failure

2.50

0.90 - 6.95

0.078

in subjects whose ejection fraction was measured (n = 835)^$

renal dysfunction

6.65

2.67 - 16.60

< 0.0001

ventricular rupture

6.93

1.22 - 39.48

0.029

ejection fraction (%)

0.88

0.85 - 0.92

< 0.0001

left main coronary artery disease

2.93

1.00 - 8.54

0.050

hypercholesterolemia

0.44

0.17 - 1.14

0.091

**Table 6.** Multivariable Odds Ratios^* of Ventricular Rupture Apart From the Disease Severity
	odds ratio	95% confidence interval	P
^* The final stage odds ratios of stepwise multivariable logistic regressions using age, female sex, obesity, diabetes, hypertension, hypercholesterolemia, renal dysfunction, current smoking, family history of myocardial infarction, angina pectoris, chronic heart failure, valvular heart disease, atrial fibrillation, hemorrhagic stroke, ischemic stroke, peripheral artery disease, aortic aneurysm, malignant disease, and other miscellaneous diseases as initial independent variables.
age (years)	1.07	1.02 - 1.12	0.0064
female sex	2.26	0.97 - 5.30	0.060
renal dysfunction	2.77	1.18 - 6.49	0.019
diabetes	2.52	1.12 - 5.71	0.026

Table 6. Multivariable Odds Ratios^* of Ventricular Rupture Apart From the Disease Severity

odds ratio

95% confidence interval

age (years)

1.07

1.02 - 1.12

0.0064

female sex

2.26

0.97 - 5.30

0.060

renal dysfunction

2.77

1.18 - 6.49

0.019

diabetes

2.52

1.12 - 5.71

0.026