Low glomerular filtration rate and risk of myocardial infarction: A systematic review and meta-analysis

Background: Chronic kidney disease is increasing in prevalence. The association between low baseline estimated glomerular filtration rate (eGFR) and future myocardial infarction has not been comprehensively assessed. Methods: A systematic review and meta-analysis of observational studies evaluating the risk for future myocardial infarction associated with eGFR <60 and 60-90 ml/min/1.73 m(2) was completed. Data sources included PubMed, EMBASE, and the Cochrane Library. Included studies were required to have prospectively collected data, followed subjects for at least 6 months, and reported baseline eGFR levels and the multivariable-adjusted relative risk for future myocardial infarction. A random effects model was used and subgroup analyses were conducted. Results: 26 publications representing 41 observational cohorts were selected. In total, 1,986,850 participants with more than 35,752 documented myocardial infarctions (follow-up range: 9 months to similar to 20 years) were evaluated. eGFR <60 ml/min/1.73 m(2) was associated with a relative risk of 1.52 (95% confidence interval 1.39-1.67; p < 0.00001) while eGFR 60-90 ml/min/1.73 m(2) was associated with a relative risk of 1.21 (1.09-1.34; p = 0.0002) for myocardial infarction. Significant heterogeneity existed among both eGFR groups. Subgroup analysis found a further increase in risk for myocardial infarction as eGFR declined from 30 to 60 to <30 ml/min/1.73 m(2) (1.40, 95% confidence interval, 1.21-1.61 vs. 1.94, 95% confidence interval, 1.51-2.50; p = 0.03). Conclusions: Decreased baseline eGFR is independently associated with increased future myocardial infarction, and the risk increases with advanced renal insufficiency. Clinicians should be wary of acute coronary syndromes in patients with CKD. Published by Elsevier Ireland Ltd.