• Lakhmir S Chawla, Richard L Amdur, Andrew D Shaw, Charles Faselis, Carlos E Palant, and Paul L Kimmel.
• Research and Medical Service, Veterans Affairs Medical Center, Washington, DC;, †Division of Renal Diseases and Hypertension, Department of Medicine, and, ‡Department of Anesthesiology and Critical Care Medicine, George Washington University, Washington, DC;, §Departments of Psychiatry and Surgery, Georgetown University School of Medicine, Washington, DC;, ‖Department of Anesthesiology, Duke University Medical Center and Veterans Affairs Medical Center, Durham, North Carolina, ¶National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
• Clin J Am Soc Nephrol. 2014 Mar 1;9(3):448-56.

Background And ObjectivesAKI is associated with major adverse kidney events (MAKE): death, new dialysis, and worsened renal function. CKD (arising from worsened renal function) is associated with a higher risk of major adverse cardiac events (MACE): myocardial infarction (MI), stroke, and heart failure. Therefore, the study hypothesis was that veterans who develop AKI during hospitalization for an MI would be at higher risk of subsequent MACE and MAKE.Design, Setting, Participants, & MeasurementsPatients in the Veterans Affairs (VA) database who had a discharge diagnosis with International Classification of Diseases, Ninth Revision, code of 584.xx (AKI) or 410.xx (MI) and were admitted to a VA facility from October 1999 through December 2005 were selected for analysis. Three groups of patients were created on the basis of the index admission diagnosis and serum creatinine values: AKI, MI, or MI with AKI. Patients with mean baseline estimated GFR<45 ml/min per 1.73 m(2) were excluded. The primary outcomes assessed were mortality, MAKE, and MACE during the study period (maximum of 6 years). The combination of MAKE and MACE-major adverse renocardiovascular events (MARCE)-was also assessed.ResultsA total of 36,980 patients were available for analysis. Mean age±SD was 66.8±11.4 years. The most deaths occurred in the MI+AKI group (57.5%), and the fewest (32.3%) occurred in patients with an uncomplicated MI admission. In both the unadjusted and adjusted time-to-event analyses, patients with AKI and AKI+MI had worse MARCE outcomes than those who had MI alone (adjusted hazard ratios, 1.37 [95% confidence interval, 1.32 to 1.42] and 1.92 [1.86 to 1.99], respectively).ConclusionsVeterans who develop AKI in the setting of MI have worse long-term outcomes than those with AKI or MI alone. Veterans with AKI alone have worse outcomes than those diagnosed with an MI in the absence of AKI.

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