1988 Volume 25 Issue 6 Pages 610-620
The purpose of this study is to investigate the pathophysiological mechanism of renal function disturbance in the early stage of acute myocardial infarction (AMI), and also to evaluate the newly defined cardiorenal subset for the prediction of early mortality (within 6 months) of AMI. Serial changes in serum creatinine (Scr), β2-microglobulin (Sβ-m), blood urea nitrogen (BUN) and creatinine clearance (Ccr) were investigated within 24 hours and between 36∼72, and 120∼468 hours after the onset of chest pain. These were compared with the severity of AMI, cardiovascular hemodynamics in 80 patients (elderly group: 37, younger group: 43 cases) in the early stage of AMI. The renal function in the elderly (≥65y.o.) and in non-surviving patients was lower than that of younger (<65y.o.) and surviving patients. In the normal subjects (n=30, 34∼84y.o.), there were significant correlation between the age and Ccr (r=-0.71), sβ-m (r=0.68), and BUN (r=0.44). When the results of renal function tests were correlated with cardiovascular hemodynamics in the elderly and younger patients, the following significant correlations were found: PCWP vs Ccr (r=-0.42), Scr (r=0.55), BUN (r=0.52) and Sβ-m (r=0.43) in elderly patients, and CI vs Ccr (r=0.56), Scr (r=-0.47), Sβ-m (r=-0.50), SVI vs Ccr (r=0.42), Scr (r=-0.64), Sβ-m (R=-0.54) in younger patients. The disturbance of renal function was more severe in patients with pulmonary edema (Killip III) or cardiogenic shock (Killip IV), compared to killip I and killip II patients. Although Ccr was less than 30ml/min in 6 out of 7 killip III cases. It was less than 30ml/min in only 4 out of 13 killip IV cases. These results suggest that disturbance of renal function in patients with killip IV might be caused by depressed cardiac function. Impaired renal function also played a pathophysiologically important role in the development of pulmonary edema in killip III cases. To investigate whether our proposed cardio-renal subset would be useful to predict early mortality in AMI cases, patients were classified into four subsets based on initial SVI and Scr:
S-I(n=46):SVI≥28ml/beat/m2, Scr≤1.5mg/dl,
S-II(n=2):SVI≥28ml/beat/m2, Scr>1.5mg/dl,
S-III(n=20):SVI<28ml/beat/m2, Scr≤1.5mg/dl,
S-IV (n=10):SVI<28ml/beat/m2, Scr>1.5mg/dl,
The early mortality rates in subset I, II, III and IV were 4.3%, 50.0%, 45.0% and 100% respectively. It was demonstrated that disturbance of renal function found in the early stage of AMI developed from the result of the prerenal influence of depressed cadiac function or preexistent incipient disturbance of renal function, possibly related to ageing. The cardio-renal subset proposed in this study appears useful to predict early mortalaity in AMI cases.
