Are there special considerations for treatment of myocardial infarction in CKD?
Patients with CKD who present with acute myocardial infarction generally do not do as well as those without kidney disease.
Furthermore, CKD patients do not do as well after percutaneous coronary intervention, with or without stenting or after coronary artery bypass grafting. The risk-benefit ratio of all these procedures should be carefully considered, and a decision should be made on a case-by-case basis.
The treatment of an acute myocardial infarction with percutaneous coronary intervention also involves a risk for acute kidney injury, which may be secondary to contrast-induced nephropathy or cholesterol emboli.
Patients at increased risk of contrast-induced nephropathy are those with a serum creatinine ≥1.5 mg/dL or an eGFR <60 mL/min per 1.73 m 2 , patients with diabetes mellitus, those treated with biguanides, and the elderly.
