Prevalence and prognosis of unrecognized myocardial infarctions in chronic kidney disease

This study makes an important contribution by being one of the first to define the burden of clinically silent myocardial infarctions in the CKD community.Unrecognized myocardial infarctions (UMIs) are common in the general population but have not been well studied in patients with chronic kidney disease (CKD). The purpose of this study was to determine the prevalence and prognosis for mortality of UMI among adults with CKD. The current study included 18 864 participants in the population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) study who completed a baseline examination including a 12-lead electrocardiogram (ECG). UMI was defined as the presence of myocardial infarction (MI) by Minnesota ECG classification in the absence of self-reported or recognized MI (RMI). Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation and albuminuria using albumin-to-creatinine ratio from a spot urine sample. All-cause mortality was assessed over a median 4 years of follow-up. The prevalence of UMI was 4, 6, 6 and 13% among participants with eGFR levels of epsilon 60, 4559.9, 3044.9 and 30 mL/min/1.73m(2), respectively, and 4, 5, 7 and 10% among participants with albuminuria levels of 10, 1029.9, 30299.9 and epsilon 300 mg/g, respectively. Compared to those with no MI, the multivariable adjusted hazard ratio for all-cause mortality associated with UMI and RMI was 1.65 [95% confidence interval (CI): 1.092.49] and 1.65 (95% CI: 1.202.26), respectively, among individuals with an eGFR 60 mL/min/1.73m(2) and 1.49 (95% CI: 1.032.16) and 1.88 (95% CI: 1.402.52) among individuals with albuminuria epsilon 30 mg/g. UMIs are common among individuals with an eGFR 60 mL/min/1.73m(2) and albuminuria and associated with an increased mortality risk.