Comparison of Chronic Kidney Disease and Risk for Presenting With Painless Versus Nonpainless Acute Myocardial Infarction

Chronic kidney disease increases the risk for developing ischemic heart disease, but it has not been well known whether it also affects the manifestation of painless acute myocardial infarction (AMI), which has important clinical implications. The aim of this study was to identify whether chronic kidney disease is associated with the presentation of painless AMI. A total of 2,656 consecutively hospitalized patients with AMI from January 2008 to February 2012 were enrolled. Estimated glomerular filtration rate (eGFR) was calculated using calibrated serum creatinine and the abbreviated Modification of Diet in Renal Disease (MDRD) equation. Patient clinical characteristics, angiographic findings, and the use of medications were reviewed. Multivariate logistic regression analysis was used to examine the association of reduced eGFR and presentation with painless AMI. A total of 2,176 adults with painful AMI and 480 adults with painless AMI were studied, and baseline eGFR was calculated. Mean eGFR was lower in subjects with painless AMI compared to those with painful AMI. Compared to an eGFR >90 ml/min/1.73 m2, a strong, graded, independent association was observed between reduced eGFR and presentation with painless AMI, with adjusted odds ratios of 1.65 (95% confidence interval 1.16 to 2.36) for an eGFR of 60 to 89 ml/min/1.73 m2, 2.92 (95% confidence interval 1.89 to 4.52) for an eGFR of 45 to 59 ml/min/1.73 m2, and 3.44 (95% confidence interval 2.20 to 5.38) for an eGFR <45 ml/min/1.73 m2. In conclusion, lower eGFR was a strong, independent predictor of presentation with painless AMI versus painful AMI.