Anemia and Renal Dysfunction Have Negative Impact on Long-Term Survival After Acute Myocardial Infarction

Anemia and chronic kidney disease (CKD) are known to worsen outcomes following acute myocardial infarction (AMI). This retrospective, single-center study evaluated the interaction between anemia and CKD in predicting 10-year survival among AMI survivors. The cohort consisted of 11,395 patients (69.1% male, mean age 65.8 years), stratified by anemia and CKD grade based on admission hemoglobin and creatinine levels.

Among participants, 29.9% had anemia and 15.9% had CKD grade 3b or higher. Anemia prevalence increased with advancing CKD grade (p < 0.001), and CKD was more severe in anemic patients. After a decade, 47.8% of the cohort had died. Despite varying baseline characteristics and treatment approaches, both anemia (HR 1.40, 95% CI 1.32-1.49, p < 0.001) and higher CKD grades (HR 1.10, 95% CI 1.02-1.20, p < 0.001) independently predicted increased mortality risk. 
The mortality risk due to anemia or worsening CKD was particularly evident in patients with normal renal function to CKD grade 3a in the overall cohort and conservative treatment subgroup, and up to grade 4 in the invasive revascularization subgroup. Notably, higher CKD grades also elevated mortality risk among non-anemic patients across CKD stages.
In conclusion, anemia and advancing CKD independently contribute to reduced long-term survival following AMI, with the combined effect posing the greatest risk in patients with mild to moderate CKD.