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Chronic kidney disease and dipstick proteinuria are risk factors for stent thrombosis in patients with myocardial infarction

Background Kidney failure (stage 5 chronic kidney disease [CKD]) is an independent risk factor for stent thrombosis (ST). Moderate (stage 3-4) CKD and proteinuria are both associated with adverse cardiovascular events, including worse outcomes after myocardial infarction (MI). Whether moderate CKD a... Full description

Journal Title: The American heart journal 2009, Vol.157 (4), p.688-694
Main Author: Lambert, Nathan D., MD
Other Authors: Sacrinty, Matthew T., MPH , Ketch, Terry R., MD , Turner, Samuel J., MD , Santos, Renato M., MD , Daniel, Kurt R., DO , Applegate, Robert J., MD , Kutcher, Michael A., MD , Sane, David C., MD
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: United States: Mosby, Inc
ID: ISSN: 0002-8703
Link: https://www.ncbi.nlm.nih.gov/pubmed/19332197
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title: Chronic kidney disease and dipstick proteinuria are risk factors for stent thrombosis in patients with myocardial infarction
format: Article
creator:
  • Lambert, Nathan D., MD
  • Sacrinty, Matthew T., MPH
  • Ketch, Terry R., MD
  • Turner, Samuel J., MD
  • Santos, Renato M., MD
  • Daniel, Kurt R., DO
  • Applegate, Robert J., MD
  • Kutcher, Michael A., MD
  • Sane, David C., MD
subjects:
  • Abridged Index Medicus
  • Acute coronary syndromes
  • Aged
  • Blood clot
  • Brain research
  • Cardiac patients
  • Cardiovascular
  • Cause of Death
  • Coronary Restenosis - complications
  • Coronary Restenosis - epidemiology
  • Coronary Restenosis - urine
  • Diabetes
  • Female
  • Follow-Up Studies
  • Heart attack
  • Heart attacks
  • Humans
  • Incidence
  • Kidney diseases
  • Kidney Failure, Chronic - epidemiology
  • Kidney Failure, Chronic - etiology
  • Kidney Failure, Chronic - urine
  • Kinases
  • Male
  • Middle Aged
  • Mortality
  • Multivariate analysis
  • Myocardial Infarction - complications
  • Myocardial Infarction - diagnosis
  • Myocardial Infarction - surgery
  • Myocardial Revascularization - instrumentation
  • North Carolina - epidemiology
  • Patients
  • Peptides
  • Prognosis
  • Proteins
  • Proteinuria
  • Proteinuria - epidemiology
  • Proteinuria - etiology
  • Proteinuria - urine
  • Retrospective Studies
  • Risk Factors
  • Stent (Surgery)
  • Stents
  • Thrombosis
  • Urinalysis - methods
ispartof: The American heart journal, 2009, Vol.157 (4), p.688-694
description: Background Kidney failure (stage 5 chronic kidney disease [CKD]) is an independent risk factor for stent thrombosis (ST). Moderate (stage 3-4) CKD and proteinuria are both associated with adverse cardiovascular events, including worse outcomes after myocardial infarction (MI). Whether moderate CKD and proteinuria increase the risk of ST after MI is not known. This study evaluated the risk of ST associated with moderate CKD and dipstick proteinuria. Methods We retrospectively analyzed clinical and laboratory data from 956 non–stage 5 CKD patients who were admitted with MI and received intracoronary stenting. Clinical follow-up was collected at 1 year for definite or probable ST, as well as for all-cause mortality, nonfatal MI or death, and target vessel revascularization or coronary artery bypass graft surgery. Results After adjustment for multiple clinical and biochemical covariates, patients with both estimated glomerular filtration rate (GFR) of 15 to 59 mL min−1 1.73 m−2 and ≥30 mg/dL dipstick proteinuria had increased cumulative incidence of ST (hazard rate [HR] 3.69, 95% CI 1.54-8.89), all-cause mortality (HR 2.68, 95% CI 1.34-5.37), and nonfatal MI or death (HR 3.20, 95% CI 1.77-5.81) at 1 year. In addition, estimated GFR of 15 to 59 mL min−1 1.73 m−2 was a significant independent predictor of ST (HR 2.61, 95% CI 1.33-5.10). Dipstick proteinuria ≥30 mg/dL was associated with a trend toward increased risk for all outcomes. Conclusions In an acute MI population, moderate CKD was identified as a novel prognostic marker for ST. In addition, patients with both decreased GFR and proteinuria had higher incidences of all-cause mortality and nonfatal MI or death than patients with either condition alone.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0002-8703
fulltext: fulltext
issn:
  • 0002-8703
  • 1097-6744
url: Link


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titleChronic kidney disease and dipstick proteinuria are risk factors for stent thrombosis in patients with myocardial infarction
sourceAlma/SFX Local Collection
creatorLambert, Nathan D., MD ; Sacrinty, Matthew T., MPH ; Ketch, Terry R., MD ; Turner, Samuel J., MD ; Santos, Renato M., MD ; Daniel, Kurt R., DO ; Applegate, Robert J., MD ; Kutcher, Michael A., MD ; Sane, David C., MD
creatorcontribLambert, Nathan D., MD ; Sacrinty, Matthew T., MPH ; Ketch, Terry R., MD ; Turner, Samuel J., MD ; Santos, Renato M., MD ; Daniel, Kurt R., DO ; Applegate, Robert J., MD ; Kutcher, Michael A., MD ; Sane, David C., MD
descriptionBackground Kidney failure (stage 5 chronic kidney disease [CKD]) is an independent risk factor for stent thrombosis (ST). Moderate (stage 3-4) CKD and proteinuria are both associated with adverse cardiovascular events, including worse outcomes after myocardial infarction (MI). Whether moderate CKD and proteinuria increase the risk of ST after MI is not known. This study evaluated the risk of ST associated with moderate CKD and dipstick proteinuria. Methods We retrospectively analyzed clinical and laboratory data from 956 non–stage 5 CKD patients who were admitted with MI and received intracoronary stenting. Clinical follow-up was collected at 1 year for definite or probable ST, as well as for all-cause mortality, nonfatal MI or death, and target vessel revascularization or coronary artery bypass graft surgery. Results After adjustment for multiple clinical and biochemical covariates, patients with both estimated glomerular filtration rate (GFR) of 15 to 59 mL min−1 1.73 m−2 and ≥30 mg/dL dipstick proteinuria had increased cumulative incidence of ST (hazard rate [HR] 3.69, 95% CI 1.54-8.89), all-cause mortality (HR 2.68, 95% CI 1.34-5.37), and nonfatal MI or death (HR 3.20, 95% CI 1.77-5.81) at 1 year. In addition, estimated GFR of 15 to 59 mL min−1 1.73 m−2 was a significant independent predictor of ST (HR 2.61, 95% CI 1.33-5.10). Dipstick proteinuria ≥30 mg/dL was associated with a trend toward increased risk for all outcomes. Conclusions In an acute MI population, moderate CKD was identified as a novel prognostic marker for ST. In addition, patients with both decreased GFR and proteinuria had higher incidences of all-cause mortality and nonfatal MI or death than patients with either condition alone.
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subjectAbridged Index Medicus ; Acute coronary syndromes ; Aged ; Blood clot ; Brain research ; Cardiac patients ; Cardiovascular ; Cause of Death ; Coronary Restenosis - complications ; Coronary Restenosis - epidemiology ; Coronary Restenosis - urine ; Diabetes ; Female ; Follow-Up Studies ; Heart attack ; Heart attacks ; Humans ; Incidence ; Kidney diseases ; Kidney Failure, Chronic - epidemiology ; Kidney Failure, Chronic - etiology ; Kidney Failure, Chronic - urine ; Kinases ; Male ; Middle Aged ; Mortality ; Multivariate analysis ; Myocardial Infarction - complications ; Myocardial Infarction - diagnosis ; Myocardial Infarction - surgery ; Myocardial Revascularization - instrumentation ; North Carolina - epidemiology ; Patients ; Peptides ; Prognosis ; Proteins ; Proteinuria ; Proteinuria - epidemiology ; Proteinuria - etiology ; Proteinuria - urine ; Retrospective Studies ; Risk Factors ; Stent (Surgery) ; Stents ; Thrombosis ; Urinalysis - methods
ispartofThe American heart journal, 2009, Vol.157 (4), p.688-694
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descriptionBackground Kidney failure (stage 5 chronic kidney disease [CKD]) is an independent risk factor for stent thrombosis (ST). Moderate (stage 3-4) CKD and proteinuria are both associated with adverse cardiovascular events, including worse outcomes after myocardial infarction (MI). Whether moderate CKD and proteinuria increase the risk of ST after MI is not known. This study evaluated the risk of ST associated with moderate CKD and dipstick proteinuria. Methods We retrospectively analyzed clinical and laboratory data from 956 non–stage 5 CKD patients who were admitted with MI and received intracoronary stenting. Clinical follow-up was collected at 1 year for definite or probable ST, as well as for all-cause mortality, nonfatal MI or death, and target vessel revascularization or coronary artery bypass graft surgery. Results After adjustment for multiple clinical and biochemical covariates, patients with both estimated glomerular filtration rate (GFR) of 15 to 59 mL min−1 1.73 m−2 and ≥30 mg/dL dipstick proteinuria had increased cumulative incidence of ST (hazard rate [HR] 3.69, 95% CI 1.54-8.89), all-cause mortality (HR 2.68, 95% CI 1.34-5.37), and nonfatal MI or death (HR 3.20, 95% CI 1.77-5.81) at 1 year. In addition, estimated GFR of 15 to 59 mL min−1 1.73 m−2 was a significant independent predictor of ST (HR 2.61, 95% CI 1.33-5.10). Dipstick proteinuria ≥30 mg/dL was associated with a trend toward increased risk for all outcomes. Conclusions In an acute MI population, moderate CKD was identified as a novel prognostic marker for ST. In addition, patients with both decreased GFR and proteinuria had higher incidences of all-cause mortality and nonfatal MI or death than patients with either condition alone.
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4Brain research
5Cardiac patients
6Cardiovascular
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8Coronary Restenosis - complications
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11Diabetes
12Female
13Follow-Up Studies
14Heart attack
15Heart attacks
16Humans
17Incidence
18Kidney diseases
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20Kidney Failure, Chronic - etiology
21Kidney Failure, Chronic - urine
22Kinases
23Male
24Middle Aged
25Mortality
26Multivariate analysis
27Myocardial Infarction - complications
28Myocardial Infarction - diagnosis
29Myocardial Infarction - surgery
30Myocardial Revascularization - instrumentation
31North Carolina - epidemiology
32Patients
33Peptides
34Prognosis
35Proteins
36Proteinuria
37Proteinuria - epidemiology
38Proteinuria - etiology
39Proteinuria - urine
40Retrospective Studies
41Risk Factors
42Stent (Surgery)
43Stents
44Thrombosis
45Urinalysis - methods
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titleChronic kidney disease and dipstick proteinuria are risk factors for stent thrombosis in patients with myocardial infarction
authorLambert, Nathan D., MD ; Sacrinty, Matthew T., MPH ; Ketch, Terry R., MD ; Turner, Samuel J., MD ; Santos, Renato M., MD ; Daniel, Kurt R., DO ; Applegate, Robert J., MD ; Kutcher, Michael A., MD ; Sane, David C., MD
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1Acute coronary syndromes
2Aged
3Blood clot
4Brain research
5Cardiac patients
6Cardiovascular
7Cause of Death
8Coronary Restenosis - complications
9Coronary Restenosis - epidemiology
10Coronary Restenosis - urine
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14Heart attack
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20Kidney Failure, Chronic - etiology
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0Lambert, Nathan D., MD
1Sacrinty, Matthew T., MPH
2Ketch, Terry R., MD
3Turner, Samuel J., MD
4Santos, Renato M., MD
5Daniel, Kurt R., DO
6Applegate, Robert J., MD
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atitleChronic kidney disease and dipstick proteinuria are risk factors for stent thrombosis in patients with myocardial infarction
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date2009
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volume157
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spage688
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pages688-694
issn0002-8703
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abstractBackground Kidney failure (stage 5 chronic kidney disease [CKD]) is an independent risk factor for stent thrombosis (ST). Moderate (stage 3-4) CKD and proteinuria are both associated with adverse cardiovascular events, including worse outcomes after myocardial infarction (MI). Whether moderate CKD and proteinuria increase the risk of ST after MI is not known. This study evaluated the risk of ST associated with moderate CKD and dipstick proteinuria. Methods We retrospectively analyzed clinical and laboratory data from 956 non–stage 5 CKD patients who were admitted with MI and received intracoronary stenting. Clinical follow-up was collected at 1 year for definite or probable ST, as well as for all-cause mortality, nonfatal MI or death, and target vessel revascularization or coronary artery bypass graft surgery. Results After adjustment for multiple clinical and biochemical covariates, patients with both estimated glomerular filtration rate (GFR) of 15 to 59 mL min−1 1.73 m−2 and ≥30 mg/dL dipstick proteinuria had increased cumulative incidence of ST (hazard rate [HR] 3.69, 95% CI 1.54-8.89), all-cause mortality (HR 2.68, 95% CI 1.34-5.37), and nonfatal MI or death (HR 3.20, 95% CI 1.77-5.81) at 1 year. In addition, estimated GFR of 15 to 59 mL min−1 1.73 m−2 was a significant independent predictor of ST (HR 2.61, 95% CI 1.33-5.10). Dipstick proteinuria ≥30 mg/dL was associated with a trend toward increased risk for all outcomes. Conclusions In an acute MI population, moderate CKD was identified as a novel prognostic marker for ST. In addition, patients with both decreased GFR and proteinuria had higher incidences of all-cause mortality and nonfatal MI or death than patients with either condition alone.
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