Renal function at the time of a myocardial infarction maintains prognostic value for more than 10 years

We examined the importance of renal function by estimated GFR (eGFR) and se-creatinine as an independent long-term prognostic factor.Prospective follow-up of 6653 consecutive MI patients screened for entry in the Trandolapril Cardiac Evaluation (TRACE) study. The patients were analysed by Kaplan-Meier survival analysis, landmark analysis and Cox proportional hazard models. Outcome measure was all-cause mortality.An eGFR below 60 ml per minute per 1.73 m2, consistent with chronic renal disease, was present in 42% of the patients. We divided the patients into 4 groups according to eGFR. Overall, Cox proportional-hazards models showed that eGFR was a significant prognostic factor in the two groups with the lowest eGFR, hazard ratio 1,72 (confidence interval (CI) 1,56-1,91) in the group with the lowest eGFR. Using the eGFR group with normal renal function as reference, we observed an incremental rise in hazard ratio. We divided the follow-up period in 2-year intervals. Landmark analysis showed that eGFR at the time of screening continued to show prognostic effect until 16 years of follow-up. By multivariable Cox regression analysis, the prognostic effect of eGFR persisted for 12 years and of se-creatinine for 10 years. When comparing the lowest group of eGFR with the group with normal eGFR, prognostic significance was present in the entire period of follow-up with a hazard ratio between 1,97 (CI 1,65-2,35) and 1,35 (CI 0,99-1,84) in the 2-year periods.One estimate of renal function is a strong and independent long-term prognostic factor for 10-12 years following a MI.The prevalence of cardiovascular disease rises with declining renal function [1-4]. The significance of impairment of kidney function for cardiovascular outcome after myocardial infarction (MI) has been examined in patients with heart failure [5], impaired left ventricular function [6] and in patients undergoing coronary artery bypass grafting (CABG) [7].Several studies have examined cardiovascular outcomes