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Renal impairment and myocardial infarction – a combination of risks Patients with renal impairment who have a myocardial infarction are a challenge throughout their medical course. On presentation they more often have atypical symptoms, troponin-levels are frequently elevated already on admission, and in spite of adequate therapies they have a higher risk of both ischemic and bleeding complications. Our knowledge of what the optimal therapy is for these patients is limited, since an elevated creatinine has often been an exclusion criterion in randomized trials. Evidence mainly comes from post-hoc analyses, sub-studies and observational studies. Lack of knowledge of which therapy is preferable contributes to under-treatment. Although about a third of all patients with myocardial infarction have at least a moderate impairment of their renal function, not all are recognized. This may result in too high doses of given medications. In this article we present the specific risks that patients with renal impairment have when they present with a myocardial infarction.

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