Clinical Manifestation, Management and Prognosis of Acute Myocardial Infarction in Autosomal Dominant Polycystic Kidney Disease

Abstract

Background/Aims: Cardiovascular complications are the most common cause of death in individuals with autosomal dominant polycystic kidney disease (ADPKD), yet there is no substantial data concerning the clinical characteristics of acute myocardial infarction (AMI) in this population. This study thus aimed to investigate AMI in persons with ADPKD. Methods: A retrospective analysis of ADPKD patients admitted to our hospital over a 13 year period was conducted. Age and gender-matched control patients without ADPKD were also selected at a ratio of 1: 10. Results: A total of 52 ADPKD and 520 non-ADPKD patients were enrolled in the present study, with those in the former group exhibiting significantly poorer kidney function. The distribution of AMI types differed significantly between these two groups. The incidence of ST-segment elevation myocardial infarction (STEMI) was higher (75.0%) and the incidence of non-ST segment elevation myocardial infarction (NSTEMI) was lower (25.0%) in the ADPKD group. At the onset of AMI, sudden cardiac death (SCD) was more common in ADPKD patients (11.5% vs. 4.6%). In terms of risk factors, the occurrence of hypertension was greater in ADPKD patients (78.8% vs. 39.6%). With regard to subsequent management, ADPKD patients had a higher prevalence of triple-branch coronary lesions (21.1% vs. 11.2%), undergoing more coronary artery bypass grafting (CABG) (7.7% vs. 5.4%) and fewer percutaneous coronary interventions (PCI) (73.1% vs. 84.6%). Overall, ADPKD patients had higher rates of mortality (13.5% vs. 6.2%). Conclusion: ADPKD patients with AMI suffer from more severe conditions and difficult therapies, resulting in a poorer prognosis.

Arrhythmogenic Hearts in PKD2 Mutant Mice Are Characterized by Cardiac Fibrosis, Systolic, and Diastolic Dysfunctions

“…In conclusion, our studies indicated fibrosis in Pkd2-KO hearts. Fibrosis in the conduction system might results in arrhythmia, and thus the PKD patients might be susceptible to atrial fibrillation (12) and potential arrhythmia-induced sudden cardiac death (47). Our studies implicated that cardiac fibrosis was also contributed to systolic and diastolic dysfunctions, which are seen in PKD patients (48).…”

Cardiovascular risk factors and the impact on prognosis in patients with chronic kidney disease secondary to autosomal dominant polycystic kidney disease

“…When a CVE occurs, it is expected to be more severe than in the general population. A study that analyzed episodes of acute myocardial infarction showed that patients with ADPKD had a higher rate of ST-segment elevation, multi-vessel involvement, and secondary sudden death [16]. However, most studies have focused on the evaluation and progression of CKD [17,18].…”

Cardiovascular Manifestations and Management in ADPKD

“…Two large cohort studies, from China and Taiwan, reported a >2-fold higher incidence of myocardial infarction in patients with ADPKD, which was associated with increased severity of coronary disease and poorer cardiovascular outcomes compared with non-ADPKD controls. 116 , 117 In particular, Yang et al. 117 showed that those with ADPKD had a higher incidence of ST-elevation myocardial infarction (75% compared with 59%), sudden cardiac death (11.5% vs. 4.6%), need for coronary artery bypass grafting (7.7% vs. 5.4%) and higher overall mortality (13.5% vs. 6.2%).…”

“… 116 , 117 In particular, Yang et al. 117 showed that those with ADPKD had a higher incidence of ST-elevation myocardial infarction (75% compared with 59%), sudden cardiac death (11.5% vs. 4.6%), need for coronary artery bypass grafting (7.7% vs. 5.4%) and higher overall mortality (13.5% vs. 6.2%). Most prior large ADPKD studies excluded patients with a history of ischemic heart disease and this may contribute to the relative paucity of data on ischemic cardiomyopathy in this group.…”