The presence of chronic kidney disease (CKD) portends a much higher mortality in patients who suffer an acute myocardial infarction. There are several potential reasons as to why this might be the case--for instance, the treatment of resultant heart failure may be much more challenging in patients with advanced CKD--but another potential reason is that at the time of presentation their CAD is fundamentally more severe.
A relevant study by Charytan et al in a 2009 Kidney International edition speaks to this issue: they analyzed a cohort of patients who underwent acute myocardial infarction with either the presence or absence of Stage 3 CKD or worse, and examined where the culprit lesion was located with respect to the cardiac vascular anatomy. Interestingly, they found that patients with CKD are much more likely to have lesions which are more proximal than those without CKD. In general, more proximal lesions are generally more severe, as ischemia may occur to a larger region of the myocardium. These results highlight the current thinking that cardiovascular disease in CKD patients may be more aggressive and severe than in the general population, and may even operate by slightly different pathophysiologic mechanisms.