Trends in Mortality Following Acute Myocardial Infarction Among Dialysis Patients in the United States Over 15 Years

Abstract

BackgroundWe sought to determine 15‐year trends in mortality rates among dialysis patients with acute myocardial infarction (AMI) in the contemporary era.Methods and ResultsUsing the US Renal Data System database, we assembled 4 study cohorts of period‐prevalent dialysis patients in 1993, 1998, 2003, and 2008 who were hospitalized for an index AMI in that calendar year. ST‐segment elevation myocardial infarction (STEMI) and non‐STEMI were identified, and in‐hospital mortality was calculated. Cumulative probability of death during 2‐year follow‐up after AMI admission was estimated by the Kaplan–Meier method and adjusted for patient characteristics. A total of 42 933 dialysis patients with AMI were included. Between 1993 (n=4494) and 2008 (n=16 361), proportional increases occurred in patient groups aged ≥75 years (23% and 31%, respectively; P<0.001), of black race (25% and 31%, respectively; P<0.001), with end‐stage renal disease due to diabetes (42% and 55%, respectively; P<0.001), and with non‐STEMI (42.2% and 80.7%, respectively; P<0.001). For all patients with AMI, in‐hospital mortality rates decreased (31.9% in 1993, 18.8% in 2008; P<0.001), as did unadjusted 2‐year cumulative probability of death after AMI admission (76.5% in 1993, 71.5% in 2008; P<0.001). Between 1993 and 2008, among STEMI patients, in‐hospital mortality (38.2% and 25.9%, P<0.001) and unadjusted 2‐year cumulative probability of mortality (77.3% and 71.2%, P<0.001) decreased, but decreases did not occur among NSTEMI patients (14.2% and 14.9%, P=0.47, and 70.9% and 70.1%, P=0.52 respectively).ConclusionsIn‐hospital mortality and 2‐year cumulative probability of death following AMI among dialysis patients decreased between 1993 and 2008 but only among STEMI patients, coincident with increased in‐hospital percutaneous coronary intervention rates. Period‐prevalent cases of non‐STEMI markedly increased without interval change in survival.

Coronary Revascularization in Patients with CKD Stage 5D: Pragmatic Considerations

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Management of coronary artery disease and acute coronary syndrome in the chronic kidney disease population—A review of the current literature

“…3 As CKD progresses, the effect on outcomes worsens in a graded manner (Table 1). 5 Unfortunately, the risk posed to CKD patients does not end at the hospitalization. In patients with CKD, but not yet on dialysis (8.6% of patients), the adjusted mortality was almost double to 3.6%, the risk of bleeding increased to 6%, and the length of stay increased to 5.4 days.…”

An overview of percutaneous coronary intervention in dialysis patients: Insights from a Japanese nationwide registry

“…and outcomes after PCI in dialysis patients remain unclear because the sample size of this group of patients is limited. [10][11][12][13][14][15] Although some previous studies have assessed clinical outcomes after PCI in dialysis patients with acute coronary syndrome (ACS), 5,11,16 few have specifically examined this matter in patients with stable CAD. 17 Such patients are often excluded from major clinical trials of cardiovascular interventions because of concerns regarding increased adverse events.…”