proved in both groups during the study period. Background CKD is present in >30% of patients with acute myocardial infarction (MI) and has been associated with lower rates of guideline-directed management and worse prognosis. We investigated the use of guideline-directed management and mortality risk in patients with and without CKD. Methods A nationwide cohort study based on health care registers encompassing all patients ≥18 years hospitalized with first-time MI in Denmark from 2010 to 2022 was conducted. CKD was defined as an eGFR <60 ml/min per 1.73 m2. Probability of guideline-directed management and risk of all-cause mortality in patients with and without CKD were calculated from adjusted multivariable logistic and Cox regression models with probabilities and risks standardized to the distribution of confounders in the population. Results In total, we identified 21,009 patients who met eligibility criteria. The median age was 72 years, and 61% of patients were male; the median eGFR was 82 ml/min per 1.73 m2, and 21% of patients had CKD. The 30-day probabilities of coronary angiography and revascularization were 71% (95% confidence interval [CI], 69% to 72%) and 78% (95% CI, 77% to 79%), P < 0.001 and 52% (95% CI, 50% to 54%) and 58% (95% CI, 58% to 59%), P < 0.001, in patients with and without CKD, respectively. Probabilities increased during the study period (P for trend 0.05, 0.03, 0.02, and 0.03, respectively). In patients with and without CKD, the probability of dual antiplatelet therapy was 67% (95% CI, 65% to 68%) and 70% (95% CI, 69% to 71%), P = 0.001, whereas the probability of lipid-lowering treatment was 76% (95% CI, 75% to 78%) and 82% (95% CI, 81% to 83%), P < 0.001, respectively. The associated 1-year mortality was 21% (95% CI, 20% to 22%) and 16.4% (95% CI, 16% to 17%) in patients with and without CKD, respectively. with decreasing mortality rates in both groups during the study period (P for trend 0.03 and 0.01). Conclusions Although survival after MI improved for all patients, CKD continued to be associated with lower use of guideline-directed management and higher mortality....

中文翻译：

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急性心肌梗死和慢性肾病：2010 年至 2022 年全国管理和结果队列研究


在研究期间在两组中都得到了证明。背景 >30% 的急性心肌梗死 （MI） 患者存在 CKD，并且与指南指导的管理率较低和预后较差有关。我们调查了 CKD 患者和非 CKD 患者采用指南指导的管理和死亡风险。方法 进行了一项基于医疗保健登记册的全国队列研究，包括 2010 年至 2022 年丹麦所有 ≥18 岁首次 MI 住院的患者。CKD 定义为 eGFR <60 ml/min 每 1.73 m2。根据调整后的多变量 logistic 和 Cox 回归模型计算有和无 CKD 患者指南导向管理的概率和全因死亡风险，并将概率和风险标准化为人群中混杂因素的分布。结果 我们总共确定了 21,009 例符合资格标准的患者。中位年龄为 72 岁，61% 的患者为男性;中位 eGFR 为 82 ml/min / 1.73 m2,21% 的患者患有 CKD。冠状动脉造影和血运重建的 30 天概率为 71%（95% 置信区间 [CI]，69% 至 72%）和 78%（95% CI，77% 至 79%），P < 0.001 和 52%（95% CI，50% 至 54%）和 58%（95% CI，58% 至 59%），P < 0.001，分别在有和没有 CKD 的患者中。研究期间概率增加 （P 分别为趋势 0.05 、 0.03 、 0.02 和 0.03）。在患有和不患有 CKD 的患者中，双重抗血小板治疗的概率为 67% （95% CI，65% 至 68%） 和 70% （95% CI，69% 至 71%），P = 0.001，而降脂治疗的概率分别为 76% （95% CI，75% 至 78%） 和 82% （95% CI，81% 至 83%），P < 0.001。 合并和非 CKD 患者的相关 1 年死亡率分别为 21% （95% CI，20% 至 22%） 和 16.4% （95% CI，16% 至 17%）。研究期间两组的死亡率均降低 （P 趋势 0.03 和 0.01）。结论 尽管所有患者 MI 后的生存率都有所提高，但 CKD 继续与指南导向管理的使用率较低和死亡率较高相关。