Email updates

Keep up to date with the latest news and content from BMC Nephrology and BioMed Central.

Open Access Research article

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

Joon Seok Choi1, Chang Seong Kim1, Eun Hui Bae1, Seong Kwon Ma1, Myung Ho Jeong12, Young Jo Kim3, Myeong Chan Cho4, Chong Jin Kim5 and Soo Wan Kim1*

Author Affiliations

1 Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju, 501-757, South Korea

2 Cardiovascular Research Institute of Chonnam National University, Gwangju, South Korea

3 Department of Internal Medicine, Yeungnam University, Daegu, South Korea

4 Department of Internal Medicine, Chungbuk National University, Cheongju, South Korea

5 Department of Internal Medicine, Kyunghee University, Seoul, South Korea

For all author emails, please log on.

BMC Nephrology 2012, 13:110  doi:10.1186/1471-2369-13-110

Published: 11 September 2012

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, β-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.

Keywords:
Myocardial infarction; Optimal medical care; Renal function