Clinical Research in Cardiology

, Volume 101, Issue 10, pp 795–803 | Cite as

Renal dysfunction as a risk factor for painless myocardial infarction: results from Korea Acute Myocardial Infarction Registry

  • Joon Seok Choi
  • Chang Seong Kim
  • Jeong Woo Park
  • Eun Hui Bae
  • Seong Kwon Ma
  • Myung Ho Jeong
  • Young Jo Kim
  • Myeong Chan Cho
  • Chong Jin Kim
  • Soo Wan Kim
  • other Korea Acute Myocardial Infarction Registry Investigators
Original Paper

Abstract

Aim

Renal dysfunction has been associated with many types of neuropathy and the incidence of myocardial infarction (MI) presenting without chest pain can be expected to be higher in patients with renal dysfunction. We evaluated clinical outcomes of painless MI patients and relationship between renal dysfunction and painless MI.

Methods and results

Study population consisted of 9,735 patients (63 ± 13 years, men 70.7 %), whose discharge diagnosis by cardiac enzyme and electrocardiogram was MI. The study subjects were divided into two groups according to presence of chest pain (painful MI group, n = 8,249; painless MI group, n = 1486). Rates of in-hospital death, 1-month and 12-month composite MACE, cardiac death, and non-cardiac death were significantly higher in painless MI patients. In a multivariate logistic analysis, compared with glomerular filtration rate (GFR) > 90 mL/min/1.73 m2, odds ratio of painless MI was increased proportionally in patients with GFR of 30–59, 15–29 and <15 mL/min/1.73 m2 (odds ratio [OR] 1.25, 95 % confidence interval [CI] 1.05–1.49; OR 1.88, CI 1.39–2.53; OR 2.32, CI 1.65–3.26) In addition, the concomitant presence of renal dysfunction and diabetes mellitus significantly affected the prevalence of painless MI.

Conclusion

Poorer outcomes of painless MI patients and the increased probability of painless MI proportional to declining GFR indicate that the possibility of painless MI should be considered in patients with renal dysfunction, particularly concomitant with diabetes mellitus.

Keywords

Clinical predictor Painless myocardial infarction Renal dysfunction 

References

  1. 1.
    Weaver WD, Simes RJ, Betriu A, Grines CL, Zijlstra F, Garcia E, Grinfeld L, Gibbons RJ, Ribeiro EE, DeWood MA, Ribichini F (1997) Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review. JAMA 278:2093–2098PubMedCrossRefGoogle Scholar
  2. 2.
    Zijlstra F, Patel A, Jones M, Grines CL, Ellis S, Garcia E, Grinfeld L, Gibbons RJ, Ribeiro EE, Ribichini F, Granger C, Akhras F, Weaver WD, Simes RJ (2002) Clinical characteristics and outcome of patients with early (<2 h), intermediate (2–4 h) and late (>4 h) presentation treated by primary coronary angioplasty or thrombolytic therapy for acute myocardial infarction. Eur Heart J 23:550–557PubMedCrossRefGoogle Scholar
  3. 3.
    Canto JG, Shlipak MG, Rogers WJ, Malmgren JA, Frederick PD, Lambrew CT, Ornato JP, Barron HV, Kiefe CI (2000) Prevalence, clinical characteristics, and mortality among patients with myocardial infarction presenting without chest pain. JAMA 283:3223–3229PubMedCrossRefGoogle Scholar
  4. 4.
    Brieger D, Eagle KA, Goodman SG, Steg PG, Budaj A, White K, Montalescot G (2004) Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high-risk group: insights from the Global Registry of Acute Coronary Events. Chest 126:461–469PubMedCrossRefGoogle Scholar
  5. 5.
    Langer A, Freeman MR, Josse RG, Armstrong PW (1995) Metaiodobenzylguanidine imaging in diabetes mellitus: assessment of cardiac sympathetic denervation and its relation to autonomic dysfunction and silent myocardial ischemia. J Am Coll Cardiol 25:610–618PubMedCrossRefGoogle Scholar
  6. 6.
    Acharya DU, Shekhar YC, Aggarwal A, Anand IS (1991) Lack of pain during myocardial infarction in diabetics—is autonomic dysfunction responsible? Am J Cardiol 68:793–796PubMedCrossRefGoogle Scholar
  7. 7.
    Campese VM, Romoff MS, Levitan D, Lane K, Massry SG (1981) Mechanisms of autonomic nervous system dysfunction in uremia. Kidney Int 20:246–253PubMedCrossRefGoogle Scholar
  8. 8.
    Heidbreder E, Schafferhans K, Heidland A (1985) Autonomic neuropathy in chronic renal dysfunction. Comparative analysis of diabetic and nondiabetic patients. Nephron 41:50–56PubMedCrossRefGoogle Scholar
  9. 9.
    Sosnov J, Lessard D, Goldberg RJ, Yarzebski J, Gore JM (2006) Differential symptoms of acute myocardial infarction in patients with kidney disease: a community-wide perspective. Am J Kidney Dis 47:378–384PubMedCrossRefGoogle Scholar
  10. 10.
    Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, Kusek JW, Van Lente F (2006) Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 145:247–254PubMedGoogle Scholar
  11. 11.
    Culic V, Eterovic D, Miric D, Silic N (2002) Symptom presentation of acute myocardial infarction: influence of sex, age, and risk factors. Am Heart J 144:1012–1017PubMedCrossRefGoogle Scholar
  12. 12.
    Tsutamoto T, Wada A, Sakai H, Ishikawa C, Tanaka T, Hayashi M, Fujii M, Yamamoto T, Dohke T, Ohnishi M, Takashima H, Kinoshita M, Horie M (2006) Relationship between renal function and plasma brain natriuretic peptide in patients with heart failure. J Am Coll Cardiol 47:582–586PubMedCrossRefGoogle Scholar
  13. 13.
    Lee KH, Kim JY, Koh SB, Lee SH, Yoon J, Han SW, Park JK, Choe KH, Yoo BS (2010) N-terminal Pro-B-type natriuretic peptide levels in the Korean general population. Korean Circ J 40:645–650PubMedCrossRefGoogle Scholar
  14. 14.
    Tsuchikura S, Shoji T, Shimomura N, Kakiya R, Emoto M, Koyama H, Ishimura E, Inaba M, Nishizawa Y (2010) Serum C-reactive protein and thioredoxin levels in subjects with mildly reduced glomerular filtration rate. BMC Nephrol 11:7PubMedCrossRefGoogle Scholar
  15. 15.
    Lonn E, Grewal J (2006) Drug therapies in the secondary prevention of cardiovascular diseases: successes, shortcomings and future directions. Curr Vasc Pharmacol 4:253–268PubMedCrossRefGoogle Scholar
  16. 16.
    Song YB, Hahn JY, Kim JH, Lee SY, Choi SH, Choi JH, Choi SH, Lee SH, Yoon J, Kim YJ, Jeong MH, Gwon HC (2010) Comparison of angiographic and other findings and mortality in non-ST-segment elevation versus ST-segment elevation myocardial infarction in patients undergoing early invasive intervention. Am J Cardiol 106:1397–1403PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Joon Seok Choi
    • 1
  • Chang Seong Kim
    • 1
  • Jeong Woo Park
    • 1
  • Eun Hui Bae
    • 1
  • Seong Kwon Ma
    • 1
  • Myung Ho Jeong
    • 1
    • 2
  • Young Jo Kim
    • 3
  • Myeong Chan Cho
    • 4
  • Chong Jin Kim
    • 5
  • Soo Wan Kim
    • 1
  • other Korea Acute Myocardial Infarction Registry Investigators
  1. 1.Department of Internal MedicineChonnam National University Medical SchoolGwangjuKorea
  2. 2.Cardiovascular Research InstituteChonnam National UniversityGwangjuKorea
  3. 3.Department of Internal MedicineYeungnam UniversityDaeguKorea
  4. 4.Department of Internal MedicineChungbuk National UniversityCheongjuKorea
  5. 5.Department of Internal MedicineKyunghee UniversitySeoulKorea

Personalised recommendations