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However, post hoc analyses in patients with eGFR http://www.selleck.cn/products/ly2157299.html characteristics. The adjusted risk for adverse events increased and was 2�C3 times higher for serious arrhythmias, heart failure and bleeding. This is consistent with other studies, which have also shown that ischemic complications such as stroke and reinfarction are more common with lower renal function [2, 17]. The cause for this excess mortality is not fully understood. A differing pathobiology may contribute to the poor outcome, in particular accelerated atherosclerosis, left ventricular hypertrophy and electrical instability, which make patients more vulnerable to complications http://www.selleckchem.com/products/dabrafenib-gsk2118436.html [18]. Other reasons may be more co-morbidities for which our models might fail to adjust for, under-use of proven therapies and toxicity of given treatments [19]. There are some limitations. In this study we have defined renal insufficiency according to an estimate from a single creatinine value. This differs from the recommended definition of chronic kidney disease which requires two measurements with 3?months interval and testing for proteinuria [8]. Although physicians were requested to report the in-hospital creatinine measurement that best corresponded to the patient��s underlying http://www.selleckchem.com/products/sch772984.html renal function, creatinine may not have reached a steady state value particularly when admitted with an acute MI. Although renal insufficiency is related to a lower use of several therapies and is independently associated with a higher rate of complication and mortality, no conclusion can be made whether therapies, had they been given, would have altered the in-hospital outcome. It is unclear why patients with renal impairment receive treatments recommended by current guidelines less frequently, and this may not be explained by this study. Factors not recorded in this database may influence whether a therapy was given. The clinician may have been unaware of the presence of renal dysfunction, not known the most appropriate therapy, or made the decision based on other considerations, including the lack of appropriate studies in this population.