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Weight N, Moledina S, Ullah M, Wijeysundera HC, Davies S, Chew NWS, Lawson C, Khan SU, Gale CP, Rashid M, Mamas MA. Impact of Chronic Kidney Disease on the Processes of Care and Long-Term Mortality of Non-ST-Segment-Elevation Myocardial Infarction: A Nationwide Cohort Study and Long-Term Follow-Up. J Am Heart Assoc 2024; 13:e032671. [PMID: 39119984 DOI: 10.1161/jaha.123.032671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 07/18/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND A growing population of patients with chronic kidney disease (CKD) presents with non-ST-segment-elevation myocardial infarction, although little is known about their longer-term mortality. METHODS AND RESULTS Using the MINAP (Myocardial Ischaemia National Audit Project) registry, linked to Office for National Statistics mortality data, we analyzed 363 559 UK patients with non-ST-segment-elevation myocardial infarction, with or without CKD. Cox regression models were fitted, adjusting for baseline demographics. Compared with patients without CKD, patients with CKD were less frequently prescribed P2Y12 inhibitors (89% versus 86%, P<0.001) less likely to undergo invasive angiography (67% versus 41%, P<0.001) or percutaneous coronary intervention (41% versus 25%, P<0.001), and were less often referred to cardiac rehabilitation (80% versus 66%, P<0.001). Following non-ST-segment-elevation myocardial infarction, patients with CKD had higher risk of 30-day (adjusted hazard ratio [HR], 1.24 [95% CI, 1.20-1.29], 1-year 1.47 [95% CI, 1.44-1.51]) and 5-year mortality 1.55 (95% CI, 1.53-1.58) than patients without CKD (all P<0.001). Risk of mortality over the entire study period was highest in CKD Stage 5 (HR, 2.98 [95% CI, 2.87-3.10]), even after excluding mortality ≤30 days (HR, 3.03 [95% CI, 2.90-3.17]) (P<0.001). There was no significant difference in proportion of deaths attributable to cardiovascular disease at 30 days (CKD; 76% versus no CKD; 76%), or 1 -year (CKD; 62% versus no CKD; 62%). CONCLUSIONS Patients with CKD were significantly less likely to receive invasive investigation or undergo percutaneous coronary intervention and had significantly higher risk of short- and longer-term mortality. Risk of mortality increased with reducing CKD stage. Cardiovascular disease was the main cause of mortality in patients with CKD, but at comparable rates to the general population with non-ST-segment-elevation myocardial infarction.
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Affiliation(s)
- Nicholas Weight
- Keele Cardiovascular Research Group, Centre for Prognosis Research Institute for Primary Care and Health Sciences, Keele University Keele Staffordshire United Kingdom
| | - Saadiq Moledina
- Keele Cardiovascular Research Group, Centre for Prognosis Research Institute for Primary Care and Health Sciences, Keele University Keele Staffordshire United Kingdom
| | - Mohsin Ullah
- Keele Cardiovascular Research Group, Centre for Prognosis Research Institute for Primary Care and Health Sciences, Keele University Keele Staffordshire United Kingdom
| | - Harindra C Wijeysundera
- Schulich Heart Program, Sunnybrook Health Sciences Centre University of Toronto, ICES Toronto Toronto Canada
| | - Simon Davies
- Department of Renal Medicine, School of Medicine Keele University Keele Staffordshire United Kingdom
| | - Nicholas W S Chew
- Department of Cardiology, National University Heart Centre National University Health System Singapore
| | - Claire Lawson
- Department of Cardiovascular Sciences University of Leicester United Kingdom
| | - Safi U Khan
- Department of Cardiology Houston Methodist DeBakey Heart and Vascular Center Houston Texas USA
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine University of Leeds United Kingdom
- Leeds Institute of Data Analytics University of Leeds United Kingdom
- Department of Cardiology Leeds Teaching Hospitals NHS Trust Leeds United Kingdom
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research Institute for Primary Care and Health Sciences, Keele University Keele Staffordshire United Kingdom
- Department of Cardiovascular Sciences Glenfield Hospital, University Hospitals of Leicester NHS Trust Leicester United Kingdom
- NIHR Leicester Biomedical Research Centre University of Leicester Leicester United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research Institute for Primary Care and Health Sciences, Keele University Keele Staffordshire United Kingdom
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre Birmingham United Kingdom
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Bilal MI, Gajjar R, Nasrullah A, Zabel KM, Vummanen S, Bobba A, Sheikh AB, Yadav N. Comparative Outcomes of Peritoneal and Hemodialysis in ESRD Patients with STEMI: A National Inpatient Sample Analysis (2016-2020). Curr Probl Cardiol 2024; 49:102690. [PMID: 38821233 DOI: 10.1016/j.cpcardiol.2024.102690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 05/28/2024] [Indexed: 06/02/2024]
Abstract
End-stage renal disease (ESRD) patients are at increased risk of mortality, particularly due to cardiovascular events such as acute myocardial infarction. Hemodialysis and peritoneal dialysis are the two main treatment modalities for ESRD patients. Using data from the National Inpatient Sample (NIS) database, we conducted a retrospective study involving 25,435 ESRD patients diagnosed with ST-elevation myocardial infarction (STEMI) between 2016 and 2020, categorized by their dialysis regimen. Our analysis revealed comparable mortality rates between peritoneal dialysis (PD) and hemodialysis (HD) patients, but lower hospitalization costs and fewer complications among PD recipients. Over five years, we observed a notable decrease in STEMI mortality despite increased STEMI cases among HD patients. Conversely, HD patients experienced increased hospital stays and associated costs over the study period than PD patients, who demonstrated stable trends. This study highlights the implications of dialysis modality selection in managing costs and reducing morbidity among STEMI patients with ESRD.
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Affiliation(s)
| | - Rohan Gajjar
- Department of Internal Medicine, John Hopkins Stronger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Adeel Nasrullah
- Department of Pulmonology and Critical Care, Allegheny Health Network, Pittsburgh, PA, USA
| | - Kenneth Matthew Zabel
- Department of Internal Medicine, University of New Mexico Health System, Albuquerque, NM, USA
| | | | - Aniesh Bobba
- Department of Cardiology, John Hopkins Stronger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health System, Albuquerque, NM, USA
| | - Neha Yadav
- Department of Cardiology, John Hopkins Stronger, Jr. Hospital of Cook County, Chicago, IL, USA
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3
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Gallacher PJ, Yeung D, Bell S, Shah ASV, Mills NL, Dhaun N. Kidney replacement therapy: trends in incidence, treatment, and outcomes of myocardial infarction and stroke in a nationwide Scottish study. Eur Heart J 2024; 45:1339-1351. [PMID: 38426727 PMCID: PMC11015953 DOI: 10.1093/eurheartj/ehae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 12/21/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND AND AIMS Patients with kidney failure have a higher risk of cardiovascular disease compared with the general population. Whilst temporal trends of myocardial infarction and stroke are declining in the general population, these have not been evaluated in patients with kidney failure. This study aimed to describe national trends in the incidence, treatment, and outcomes of myocardial infarction and stroke in patients with kidney failure (i.e. on dialysis or with a kidney transplant) over a 20-year period, stratified by age and sex. METHODS In this retrospective national data linkage study, all patients with kidney failure in Scotland (UK) receiving kidney replacement therapy between January 1996 and December 2016 were linked to national hospitalization, prescribing, and death records. The primary outcomes were the incidence of myocardial infarction and stroke, and subsequent cardiovascular death. Generalized additive models were constructed to estimate age-standardized, sex-stratified incidence rates and trends in cardiovascular and all-cause death. RESULTS Amongst 16 050 patients with kidney failure [52 (SD 15) years; 41.5% women], there were 1992 [66 (SD 12) years; 34.8% women] and 996 [65 (SD 13) years; 45.1% women] incident myocardial infarctions and strokes, respectively, between January 1996 and December 2016. During this period, the age-standardized incidence of myocardial infarction per 100 000 decreased in men {from 4376 [95% confidence interval (CI) 3998-4785] to 1835 (95% CI 1692-1988)} and women [from 3268 (95% CI 2982-3593) to 1369 (95% CI 1257-1491)]. Similarly, the age-standardized incidence of stroke per 100 000 also decreased in men [from 1978 (95% CI 1795-2175) to 799 (95% CI 729-875)] and women [from 2234 (95% CI 2031-2468) to 903 (95% CI 824-990)]. Compared with the general population, the incidence of myocardial infarction was four- to eight-fold higher in patients with kidney failure, whilst for stroke it was two- to four-fold higher. The use of evidence-based cardioprotective treatment increased over the study period, and the predicted probability of cardiovascular death within 1 year of myocardial infarction for a 66-year-old patient with kidney failure (mean age of the cohort) fell in men (76.6% to 38.6%) and women (76.8% to 38.8%), and also decreased in both sexes following stroke (men, from 63.5% to 41.4%; women, from 67.6% to 45.8%). CONCLUSIONS The incidence of myocardial infarction and stroke has halved in patients with kidney failure over the past 20 years but remains significantly higher than in the general population. Despite improvements in treatment and outcomes, the prognosis of these patients following myocardial infarction and stroke remains poor.
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Affiliation(s)
- Peter J Gallacher
- BHF/University Centre for Cardiovascular Science, Little France Crescent, University of Edinburgh, Edinburgh EH16 4SA, UK
| | - David Yeung
- BHF/University Centre for Cardiovascular Science, Little France Crescent, University of Edinburgh, Edinburgh EH16 4SA, UK
| | - Samira Bell
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
- Scottish Renal Registry, Scottish Health Audits, Public Health Scotland, Glasgow, UK
| | - Anoop S V Shah
- Department of Non-Communicable Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Nicholas L Mills
- BHF/University Centre for Cardiovascular Science, Little France Crescent, University of Edinburgh, Edinburgh EH16 4SA, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Neeraj Dhaun
- BHF/University Centre for Cardiovascular Science, Little France Crescent, University of Edinburgh, Edinburgh EH16 4SA, UK
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
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Chiang CH, Hung WT, Tai TH, Cheng CC, Lin KC, Kuo SH, Lin SC, Tang PL, Gao CE, Weng PY, Ko YL, Fu YJ, Kuo FY, Huang WC. The impact of end-stage kidney disease on mortality in patients after acute myocardial infarction: A nationwide study. J Chin Med Assoc 2023; 86:740-747. [PMID: 37399580 DOI: 10.1097/jcma.0000000000000953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the impact of end-stage kidney disease (ESKD) on mortality in patients with first-time acute myocardial infarction (AMI). METHODS This was a retrospective nationwide cohort study. Patients diagnosed with first-time AMI between January 1, 2000, and December 31, 2012, were included. All patients were followed-up until death or December 31, 2012, whichever occurred first. A one-to-one propensity score matching technique was used to match patients with ESKD to those without ESKD of similar sex, age, comorbidities, and coronary intervention (including percutaneous coronary intervention [PCI] and coronary artery bypass grafting [CABG]). Kaplan-Meier cumulative survival curves were constructed to compare AMI patients with and without ESKD. RESULTS A total of 186 112 patients were enrolled and 8056 patients with ESKD were identified. Propensity score matched 8056 patients without ESKD were included in the comparison. Overall, the 12-year mortality rate was significantly higher in patients with ESKD than in those without ESKD (log-rank p < 0.0001), including the sex, age, and PCI and CABG subgroups. In Cox proportional-hazard regression analysis, ESKD was an independent risk factor for mortality after patients suffered from first-time AMI (hazard ratio, 1.77; 95% CI, 1.70-1.84; p < 0.0001). A forest plot for subgroup analysis revealed that in AMI patients, ESKD had a higher impact on mortality in male; younger age; without comorbidities such as hypertension, diabetes mellitus, peripheral vascular disease, heart failure, cerebrovascular accident, and chronic obstructive pulmonary disease; and receiving PCI and CABG subgroups. CONCLUSION ESKD significantly increases the mortality risk in patients with first-time AMI, including both sexes, different ages, and whether PCI or CABG was performed. In patients with AMI, ESKD has a high impact on mortality in male, younger age, without comorbidities, and those undergoing PCI and CABG.
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Affiliation(s)
- Cheng-Hung Chiang
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Physical Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Cardiology, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan, ROC
- Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan, ROC
- Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Wan-Ting Hung
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Ta-Hsin Tai
- Department of Cardiology, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan, ROC
| | - Chin-Chang Cheng
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan, ROC
| | - Kun-Chang Lin
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Shu-Hung Kuo
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Su-Chiang Lin
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Pei-Ling Tang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Chong-En Gao
- Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Pei-Yu Weng
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yu-Ling Ko
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yun-Ju Fu
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Feng-Yu Kuo
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Wei-Chun Huang
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan, ROC
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
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Tan E, Liu D, Perry L, Zhu J, Cid-Serra X, Deane A, Yeo C, Ajani A. Cell-free DNA as a potential biomarker for acute myocardial infarction: A systematic review and meta-analysis. IJC HEART & VASCULATURE 2023; 47:101246. [PMID: 37560328 PMCID: PMC10407200 DOI: 10.1016/j.ijcha.2023.101246] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/27/2023] [Accepted: 07/07/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Tissue necrosis releases cell-free deoxyribonucleic acid (cfDNA), leading to rapid increases in plasma concentration with clearance independent of kidney function. AIM To explore the diagnostic role of cfDNA in acute myocardial infarction (AMI). METHODS This systematic review and meta-analysis included studies of cfDNA in patients with AMI and a comparator group without AMI. The quality assessment of diagnostic accuracy studies-2 (QUADAS-2) tool was used, with AMI determined from the criteria of the original study. Standardised mean differences (SMD) were obtained using a random-effects inverse variance model. Heterogeneity was reported as I2. Pooled sensitivity and specificity were computed using a bivariate model. The area under the curve (AUC) was estimated from a hierarchical summary receiver operating characteristics curve. RESULTS Seventeen studies were identified involving 1804 patients (n = 819 in the AMI group, n = 985 in the comparator group). Circulating cfDNA concentrations were greater in the AMI group (SMD 3.47 (95%CI: 2.54-4.41, p < 0.001)). The studies were of variable methodological quality with substantial heterogeneity (I2 = 98%, p < 0.001), possibly due to the differences in cfDNA quantification methodologies (Chi2 25.16, p < 0.001, I2 = 92%). Diagnostic accuracy was determined using six studies (n = 804), which yielded a sensitivity of 87% (95%CI: 72%-95%) and specificity of 96% (95%CI: 92%-98%). The AUC was 0.96 (95%CI: 0.93-0.98). Two studies reported a relationship between peak cfDNA and peak troponin. No studies reported data for patients with pre-existing kidney impairment. CONCLUSION Plasma cfDNA appears to be a reliable biomarker of myocardial injury. Inferences from existing results are limited owing to methodology heterogeneity.
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Affiliation(s)
- Elinor Tan
- Department of Intensive Care Unit, The Royal Melbourne Hospital, Melbourne, Australia
| | - Daniel Liu
- Department of Anesthesiology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Luke Perry
- Department of Anesthesiology, The Royal Melbourne Hospital, Melbourne, Australia
| | - John Zhu
- Department of General Medicine, The Royal Melbourne Hospital, Melbourne, Australia
| | - Ximena Cid-Serra
- Department of General Medicine, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Adam Deane
- Department of Intensive Care Unit, The Royal Melbourne Hospital, Melbourne, Australia
| | - Colin Yeo
- Department of Cardiology, Changi General Hospital, Singapore
| | - Andrew Ajani
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia
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Gao P, Zou X, Sun X, Zhang C. Coronary Artery Disease in CKD-G5D Patients: An Update. Rev Cardiovasc Med 2023; 24:227. [PMID: 39076724 PMCID: PMC11266819 DOI: 10.31083/j.rcm2408227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 07/31/2024] Open
Abstract
Patients with chronic kidney disease treated by dialysis (CKD-G5D) are characterized by a high prevalence of coronary artery disease (CAD). Such patients differ from non-uremic CAD patients and have been excluded from several clinical CAD trials. CKD-G5D patients may be asymptomatic for their CAD, making their risk stratification and management challenging. This review will focus on the incidence, epidemiology, pathophysiology, screening tools, and management/treatment of CAD in CKD-G5D patients. It will also review recent studies concerning the screening tools and management strategies available for these patients. The need for improved evaluation of cardiovascular risk factors, screening and early intervention for symptomatic CAD in CKD-G5D patients will be highlighted.
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Affiliation(s)
- Pan Gao
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Technology, 430022 Wuhan, Hubei, China
| | - Xingjian Zou
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Technology, 430022 Wuhan, Hubei, China
| | - Xin Sun
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Technology, 430022 Wuhan, Hubei, China
| | - Chun Zhang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Technology, 430022 Wuhan, Hubei, China
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Zhang Z, Wang Y. Management of Cardiovascular Diseases in Chronic Hemodialysis Patients. Rev Cardiovasc Med 2023; 24:185. [PMID: 39077004 PMCID: PMC11266462 DOI: 10.31083/j.rcm2407185] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 02/01/2023] [Accepted: 02/23/2023] [Indexed: 07/31/2024] Open
Abstract
Hemodialysis (HD) is the main treatment modality for patients with end-stage kidney disease. Cardiovascular diseases (CVD) are highly prevalent in HD patients and are the leading cause of death in this population, with the mortality from CVD approximately 20 times higher than that of the general population. Traditional and non-traditional cardiovascular risk factors accelerate progression of CVD and exacerbate the prognosis in HD patients. This review provides a brief overview of the characteristics of CVD in HD patients, and a description of advances in its management.
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Affiliation(s)
- Zhen Zhang
- Department of Nephrology, Zhongshan Hospital, Fudan University, 200032 Shanghai, China
- Shanghai Medical Center for Kidney Disease, Shanghai Municipal Health Commission, 200032 Shanghai, China
- Shanghai Institute of Kidney and Dialysis, 200032 Shanghai, China
- Hemodialysis Quality Control Center of Shanghai, Shanghai Medical Quality Control Management Center, 200032 Shanghai, China
| | - Yaqiong Wang
- Department of Nephrology, Zhongshan Hospital, Fudan University, 200032 Shanghai, China
- Shanghai Medical Center for Kidney Disease, Shanghai Municipal Health Commission, 200032 Shanghai, China
- Shanghai Institute of Kidney and Dialysis, 200032 Shanghai, China
- Hemodialysis Quality Control Center of Shanghai, Shanghai Medical Quality Control Management Center, 200032 Shanghai, China
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Cosentino N, Genovesi S, Bonomi A, Trombara F, Ludergnani M, Leoni O, Bortolan F, Agostoni P, Marenzi G. Prognostic Impact of Percutaneous Coronary Intervention in Chronic Dialysis Patients with Acute Myocardial Infarction: Findings from the Lombardy Health Database. Rev Cardiovasc Med 2023; 24:135. [PMID: 39076740 PMCID: PMC11273045 DOI: 10.31083/j.rcm2405135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/01/2023] [Accepted: 04/10/2023] [Indexed: 07/31/2024] Open
Abstract
Background Patients on chronic dialysis are less likely to be treated with percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). This is due to the lack of evidence from randomized trials, concerns about possible PCI-related side effects, and multimorbidity. Therefore, routine use of PCI for treatment of dialysis patients with AMI remains an unresolved issue. Methods We analyzed data of patients on chronic dialysis hospitalized with AMI from 2003 to 2018, by using the administrative Lombardy Health Database (Italy). Patients were grouped according to whether they underwent or not PCI during index hospitalization. The primary outcome was in-hospital mortality, 1-year mortality was the secondary endpoint. Results During the study period, 265,048 patients were hospitalized with AMI. Of them, 3206 (1.2%) were on chronic dialysis (age 71 ± 11; 72% males). Among dialysis patients, 44% underwent PCI, while 54% underwent PCI among non-dialysis patients (p < 0.0001). Dialysis was an independent predictor of treatment with medical therapy only (OR 0.75 [95% CI 0.70-0.81]). In-hospital mortality in the dialysis cohort was 15%, significantly lower in patients treated with PCI than in those not treated with PCI (11% vs. 19%; p < 0.0001). One-year mortality was 47% and it was lower in PCI-treated patients (33% vs. 52%; p < 0.0001). The adjusted risk of the study endpoints was significantly lower in dialysis patients undergoing PCI: OR 0.62 (95% CI 0.50-0.76) for in-hospital mortality; HR 0.63 (95% CI 0.56-0.71) for 1-year mortality. Conclusions This study showed that in AMI patients on chronic dialysis, PCI is associated with a significant in-hospital and 1-year survival benefit. Yet, they underwent PCI less frequently than patients with preserved renal function.
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Affiliation(s)
| | - Simonetta Genovesi
- School of Medicine and Surgery, Nephrology Clinic, Milano-Bicocca University, 20900 Monza, Italy
- Istituto Auxologico Italiano, IRCCS, 20133 Milan, Italy
| | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy
| | | | | | - Olivia Leoni
- Regional Epidemiological Observatory, Lombardy Region, 20100 Milan, Italy
| | - Francesco Bortolan
- Regional Epidemiological Observatory, Lombardy Region, 20100 Milan, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, 20159 Milan, Italy
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Ocak G, Boenink R, Noordzij M, Bos WJW, Vikse BE, Cases A, Kerschbaum J, Helve J, Nordio M, Arici M, Mercadal L, Wanner C, Palsson R, Hommel K, De Meester J, Kostopoulou M, Santamaria R, Rodrigo E, Rydell H, Bell S, Massy ZA, Jager KJ, Kramer A. Trends in Mortality Due to Myocardial Infarction, Stroke, and Pulmonary Embolism in Patients Receiving Dialysis. JAMA Netw Open 2022; 5:e227624. [PMID: 35435972 PMCID: PMC9016490 DOI: 10.1001/jamanetworkopen.2022.7624] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE During the past decades, improvements in the prevention and management of myocardial infarction, stroke, and pulmonary embolism have led to a decline in cardiovascular mortality in the general population. However, it is unknown whether patients receiving dialysis have also benefited from these improvements. OBJECTIVE To assess the mortality rates for myocardial infarction, stroke, and pulmonary embolism in a large cohort of European patients receiving dialysis compared with the general population. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, adult patients who started dialysis between 1998 and 2015 from 11 European countries providing data to the European Renal Association Registry were and followed up for 3 years. Data were analyzed from September 2020 to February 2022. EXPOSURES Start of dialysis. MAIN OUTCOMES AND MEASURES The age- and sex-standardized mortality rate ratios (SMRs) with 95% CIs were calculated by dividing the mortality rates in patients receiving dialysis by the mortality rates in the general population for 3 equal periods (1998-2003, 2004-2009, and 2010-2015). RESULTS In total, 220 467 patients receiving dialysis were included in the study. Their median (IQR) age was 68.2 (56.5-76.4) years, and 82 068 patients (37.2%) were female. During follow-up, 83 912 patients died, of whom 7662 (9.1%) died because of myocardial infarction, 5030 (6.0%) died because of stroke, and 435 (0.5%) died because of pulmonary embolism. Between the periods 1998 to 2003 and 2010 to 2015, the SMR of myocardial infarction decreased from 8.1 (95% CI, 7.8-8.3) to 6.8 (95% CI, 6.5-7.1), the SMR of stroke decreased from 7.3 (95% CI, 7.0-7.6) to 5.8 (95% CI, 5.5-6.2), and the SMR of pulmonary embolism decreased from 8.7 (95% CI, 7.6-10.1) to 5.5 (95% CI, 4.5-6.6). CONCLUSIONS AND RELEVANCE In this cohort study of patients receiving dialysis, mortality rates for myocardial infarction, stroke, and pulmonary embolism decreased more over time than in the general population.
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Affiliation(s)
- Gurbey Ocak
- Department of Internal Medicine, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Rianne Boenink
- European Renal Association Registry, Department of Medical Informatics, Amsterdam Universitair Medische Centra, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Marlies Noordzij
- European Renal Association Registry, Department of Medical Informatics, Amsterdam Universitair Medische Centra, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Willem Jan W. Bos
- Department of Internal Medicine, Sint Antonius Hospital, Nieuwegein, the Netherlands
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Bjorn E. Vikse
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Medicine, Haugesund Hospital, Haugesund, Norway
| | - Aleix Cases
- Nephrology Department, Hospital Clínic, Universitat de Barcelona, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
- Registre de Malalts Renals de Catalunya, Barcelona, Spain
| | - Julia Kerschbaum
- Department of Internal Medicine IV - Nephrology and Hypertension, Austrian Dialysis and Transplant Registry, Medical University Innsbruck, Innsbruck, Austria
| | - Jaakko Helve
- Finnish Registry for Kidney Diseases, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Maurizio Nordio
- Veneto Dialysis and Transplantation Registry, Regional Epidemiology System, Padua, Italy
- Nephrology Dialysis and Renal Transplantation Unit, Treviso, Italy
| | - Mustafa Arici
- Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Lucile Mercadal
- Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital de La Pitié Salpêtrière Hospital, Paris, France
| | - Christoph Wanner
- Division of Nephrology, Department of Medicine, University Hospital of Würzburg, Würzburg, Germany
| | - Runolfur Palsson
- Division of Nephrology, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Johan De Meester
- Department of Nephrology, Dialysis and Hypertension, Dutch-speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium
| | | | - Rafael Santamaria
- Andalusian Autonomous Transplant Coordination Information System, Seville, Spain
- Nephrology ServiceReina Sofia University Hospital, Cordoba, Spain
| | - Emilio Rodrigo
- Nephrology Service, University Hospital Marqués de Valdecilla/IDIVAL, University of Cantabria, Santander, Spain
| | - Helena Rydell
- Division of Renal Medicine, Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Swedish Renal Registry, Department of Internal Medicine, Ryhov Regional Hospital, Jönköping, Sweden
| | - Samira Bell
- Scottish Renal Registry, Meridian Court, Glasgow, United Kingdom
- Division of Population health And Genomics, University of Dundee, Dundee, United Kingdom
| | - Ziad A. Massy
- Division of Nephrology, Ambroise Paré University Hospital, Boulogne-Billancourt, France
- Institut National de la Santé et de la Recherche Médicale, Research Centre in Epidemiology and Population Health, University of Paris Ouest-Versailles-St Quentin-en-Yveline, Villejuif, France
| | - Kitty J. Jager
- European Renal Association Registry, Department of Medical Informatics, Amsterdam Universitair Medische Centra, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Anneke Kramer
- European Renal Association Registry, Department of Medical Informatics, Amsterdam Universitair Medische Centra, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
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10
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Invasive coronary artery disease assessment and myocardial infarction in patients on renal replacement therapy. Int Urol Nephrol 2022; 54:2083-2092. [DOI: 10.1007/s11255-022-03115-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/11/2022] [Indexed: 11/25/2022]
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11
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Shroff GR, Carlson MD, Mathew RO. Coronary Artery Disease in Chronic Kidney Disease: Need for a Heart-Kidney Team-Based Approach. Eur Cardiol 2021; 16:e48. [PMID: 34950244 PMCID: PMC8674634 DOI: 10.15420/ecr.2021.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/19/2021] [Indexed: 01/10/2023] Open
Abstract
Chronic kidney disease and coronary artery disease are co-prevalent conditions with unique epidemiological and pathophysiological features, that culminate in high rates of major adverse cardiovascular outcomes, including all-cause mortality. This review outlines a summary of the literature, and nuances pertaining to non-invasive risk assessment of this population, medical management options for coronary heart disease and coronary revascularisation. A collaborative heart-kidney team-based approach is imperative for critical management decisions for this patient population, especially coronary revascularisation; this review outlines specific periprocedural considerations pertaining to coronary revascularisation, and provides a proposed algorithm for approaching revascularisation choices in patients with end-stage kidney disease based on available literature.
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Affiliation(s)
- Gautam R Shroff
- Division of Cardiology, Department of Medicine, Hennepin Healthcare & University of Minnesota Medical School Minneapolis, MN, US
| | - Michelle D Carlson
- Division of Cardiology, Department of Medicine, Hennepin Healthcare & University of Minnesota Medical School Minneapolis, MN, US
| | - Roy O Mathew
- Division of Nephrology, Department of Medicine, Columbia VA Health Care System Columbia, SC, US
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12
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Raftopoulos L, Aggeli C, Dimitroglou Y, Kakiouzi V, Tsartsalis D, Patsourakos D, Tsioufis C. The fundamental role of stress echo in evaluating coronary artery disease in specific patient populations. Curr Vasc Pharmacol 2021; 20:156-167. [PMID: 34931964 DOI: 10.2174/1570161120666211220104156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/06/2021] [Accepted: 11/19/2021] [Indexed: 11/22/2022]
Abstract
Stress echocardiography (SE) was initially used for assessing patients with known or suspected coronary heart disease by detecting and evaluating myocardial ischemia and viability. The implementation of SE has gradually been extended to several cardiovascular diseases beyond coronary artery disease, and SE protocols have been modified and adapted for the detection of coronary artery disease (CAD) or other cardiovascular diseases in specific patient populations. This review attempts to summarize current data concerning SE implementation and clinical value in these specific and diverse populations: patients with an intramural course of a coronary artery - known as a myocardial bridge, chronic severe or end-stage hepatic disease, chronic severe or end-stage kidney disease, cardiac allograft vasculopathy, patients scheduled for solid-organ transplantation and other intermediate and high-risk surgery and, finally, patients treated with anticancer drugs or radiotherapy.
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Affiliation(s)
- Leonidas Raftopoulos
- First Department of Cardiology, University of Athens Medical School, General Hospital of Athens Hippokration, Athens, Greece
| | - Constantina Aggeli
- First Department of Cardiology, University of Athens Medical School, General Hospital of Athens Hippokration, Athens, Greece
| | - Yannis Dimitroglou
- First Department of Cardiology, University of Athens Medical School, General Hospital of Athens Hippokration, Athens, Greece
| | - Vasiliki Kakiouzi
- First Department of Cardiology, University of Athens Medical School, General Hospital of Athens Hippokration, Athens, Greece
| | - Dimitrios Tsartsalis
- First Department of Cardiology, University of Athens Medical School, General Hospital of Athens Hippokration, Athens, Greece
| | - Dimitrios Patsourakos
- First Department of Cardiology, University of Athens Medical School, General Hospital of Athens Hippokration, Athens, Greece
| | - Costas Tsioufis
- First Department of Cardiology, University of Athens Medical School, General Hospital of Athens Hippokration, Athens, Greece
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13
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Prognosis of acute myocardial infarction in patients on hemodialysis stratified by Killip classification in the modern interventional era (focus on the prognosis of Killip class 1). Heart Vessels 2021; 37:208-218. [PMID: 34347137 DOI: 10.1007/s00380-021-01919-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/28/2021] [Indexed: 12/22/2022]
Abstract
Cardiovascular events and death are more prevalent in hemodialysis (HD) patients than in the general population. However, a detailed prognostic risk stratification of HD patients with acute myocardial infarction (AMI) has not yet been performed in the modern interventional era. We examined 4509 AMI patients (89 AMI/HD and 4420 AMI/non-HD) from the Mie ACS registry and detailed prognostic analyses based on the Killip classification were performed (Cohort A). In addition, prognosis of Killip class1 AMI/HD was compared with those of 313 non-AMI/HD patients from the MIE-CARE HD study using propensity score-matching method (Cohort B). Primary endpoint was all-cause mortality for up to 2 years. All-cause death occurred in 13.0% of AMI/non-HD and 35.8% of AMI/HD during follow-up, and patients with Killip class 1 had lower 30-day and 2-year mortality than those with Killip class ≥ 2 in both AMI/non-HD and AMI/HD. Cox regression analyses identified that Killip class ≥ 2 was the strongest independent prognostic factor of 30-day mortality with a hazard ratio of 7.44 (p < 0.001), whereas both presence of HD and Killip class ≥ 2 were the independent prognostic factors of mortality for up to 2 years. In Cohort B, a propensity score-matching analysis revealed similar all-cause mortality rates between Killip class 1 AMI/HD and non-AMI/HD. In HD patients with Killip class 1 AMI, 30-day mortality was around 6%, and long-term mortality among 30-day survivors after AMI was comparable with the natural course of HD patients in the modern interventional era. Clinical trial registration: URL: https://www.umin.ac.jp/ctr/index-j.htm . UMIN000036020 and UMIN000008128.
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14
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Abstract
AIMS Despite recent progress in coronary artery disease treatment, ST-segment elevation myocardial infarction (STEMI) remains a very high-risk medical condition. Whether recent patients' outcomes, following implementation of the 2012 European Society of Cardiology (ESC) STEMI guidelines have improved, is yet unclear. METHODS AND RESULTS The study was based on a prospective detailed registry of 2004 consecutive patients with STEMI treated with primary percutaneous coronary intervention (pPCI). We compared trends during two different time periods (2006-2012 vs. 2012-2018). Endpoints included mortality and major adverse cardiac events (MACE: death, repeat myocardial infarction, target vessel revascularization and coronary artery bypass surgery) at 1 month, 1 and 2 years. Rates of transradial interventions have risen significantly (67.3 vs. 42.0%; P < 0.01), as have rates of prasugrel administration (69.8 vs. 4.5%; P < 0.01) and use of drug eluting stents (75.5 vs. 56.5%; P < 0.01). Both at 1 and at 2 years, MACE was significantly lower in the later period (11.6 vs. 20.9%; P < 0.01 and 18.9 vs. 25.4%; P < 0.01 respectively), whereas mortality was only significantly lower after 1 year (5.8 vs. 8.6%; P = 0.02). Cox regression identified the later period (2012-2018) to independently and favorably impact MACE (hazard ratio, -0.69; 95% CI, 0.56-0.85; P < 0.01) but not mortality (hazard ratio, -0.76; 95% CI, 0.54-1.05; P = 0.09). CONCLUSION Among patients treated with pPCI for STEMI, adoption of the contemporary evidence-based treatments is associated with better MACE derived outcomes, following the inception of the 2012 ESC guidelines. Nonetheless, the long-term mortality was marginally (but not significantly) lower, which indicates an unmet need for further improvement.
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15
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Liu ZY, Yin ZH, Liang CY, He J, Wang CL, Peng X, Zhang Y, Zheng ZF, Pan HW. Zero contrast optical coherence tomography-guided percutaneous coronary intervention in patients with non-ST segment elevation myocardial infarction and chronic kidney disease. Catheter Cardiovasc Interv 2021; 97 Suppl 2:1072-1079. [PMID: 33764682 DOI: 10.1002/ccd.29655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/14/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To investigate a strategy for ultra-low volume contrast percutaneous coronary intervention (PCI) with the aims of preserving renal function and observing the 90-day clinical endpoint in patients with non-ST-elevated myocardial infarction (non-STEMI) and chronic kidney disease (CKD). BACKGROUND The feasibility, safety, and clinical utility of PCI with ultra-low radio-contrast medium in patients with non-STEMI and CKD are unknown. METHODS A total of 29 patients with non-STEMI and CKD (estimated glomerular filtration rate [eGFR] of ≤60 ml/min/1.73 m2 ) were included. Ultra-low volume contrast PCI was performed after minimal contrast coronary angiography using zero contrast optical coherence tomography (OCT) guidance. Pre- and post-PCI angiographic measurements were performed using quantitative flow ratio (QFR) for pre-perfusion assessment and verifying improvement. RESULTS The median creatinine level was 2.1 (inter-quartile range 1.8-3.3), and mean eGFR was 48 ± 8 ml/min/1.73 m2 pre-PCI. During the PCI procedure, OCT revealed 15 (52%) cases of abnormalities post-dilation. There was no significant change in the creatinine level and eGFR in the short- or long-term, and no major adverse events were observed. CONCLUSION In non-STEMI patients with high-risk CKD who require revascularization, QFR and no contrast OCT-guided ultra-low contrast PCI may be performed safely without major adverse events.
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Affiliation(s)
- Zheng-Yu Liu
- Department of Cardiology, Hunan Provincial People's Hospital, Changsha, Hunan, China.,Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Zi-Hui Yin
- The First Affiliated Hospital, Hunan Normal University, Changsha, Hunan, China
| | - Cheng-Yang Liang
- Interventional Vascular Complex Operation Department, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Jing He
- Department of Cardiology, Hunan Provincial People's Hospital, Changsha, Hunan, China.,Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Chang-Lu Wang
- Department of Cardiology, Hunan Provincial People's Hospital, Changsha, Hunan, China.,Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Xiang Peng
- Department of Cardiology, Hunan Provincial People's Hospital, Changsha, Hunan, China.,Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Yu Zhang
- Department of Cardiology, Hunan Provincial People's Hospital, Changsha, Hunan, China.,Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Zhao-Fen Zheng
- Department of Cardiology, Hunan Provincial People's Hospital, Changsha, Hunan, China.,Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Hong-Wei Pan
- Department of Cardiology, Hunan Provincial People's Hospital, Changsha, Hunan, China.,Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Provincial People's Hospital, Changsha, Hunan, China
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16
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Abstract
BACKGROUND Acute coronary syndrome (ACS) is prevalent in continuous ambulatory peritoneal dialysis (CAPD) patients. However, the association between the apoprotein profile and ACS is not well known. Therefore, we aimed to investigate the relationship between apoproteins and ACS in CAPD patients. METHODS Eighty-one CAPD patients were included in this retrospective study. The primary endpoint was ACS. Predictors were baseline apoprotein levels, particularly the ratio of apoprotein A1 (Apo A1)/apoprotein B (Apo B). Cox regression was used to determine the relationship between Apo A1/Apo B and ACS. RESULTS During follow-up, 34 (41.98%) CAPD patients experienced an ACS. ACS patients had higher levels of total cholesterol (p = 0.03), low-density lipoprotein cholesterol (LDL-C) (p = 0.04), C-reactive protein (p = 0.01), and Apo B (p < 0.01). However, hemoglobin (p = 0.01) and Apo A1/Apo B (p < 0.01) were lower in the ACS group than the non-ACS group. Patients with Apo A1/Apo B ≥ 1.105 experienced fewer ACS compared with those with Apo A1/Apo B < 1.105 (33.33% vs. 75.56%, p = 0.03). In Cox regression, Apo A1/Apo B (RR, 0.06; 95% CI, 0.00-0.77; p = 0.03) was independently associated with ACS. CONCLUSIONS Apo A1/Apo B was strongly associated with ACS and may be considered as a predictor of future ACS in CAPD patients.
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Affiliation(s)
- Tianlei Chen
- Department of Nephrology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, PR China
| | - Min Yang
- Department of Nephrology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, PR China
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17
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O'Lone E, Howell M, Viecelli AK, Craig JC, Tong A, Sautenet B, Herrington WG, Herzog CA, Jafar TH, Jardine M, Krane V, Levin A, Malyszko J, Rocco MV, Strippoli G, Tonelli M, Wang AYM, Wanner C, Zannad F, Winkelmayer WC, Wheeler DC. Identifying critically important cardiovascular outcomes for trials in hemodialysis: an international survey with patients, caregivers and health professionals. Nephrol Dial Transplant 2021; 35:1761-1769. [PMID: 32040154 DOI: 10.1093/ndt/gfaa008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/17/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is a major contributor to morbidity and mortality in people on hemodialysis (HD). Cardiovascular outcomes are reported infrequently and inconsistently across trials in HD. This study aimed to identify the priorities of patients/caregivers and health professionals (HPs) for CVD outcomes to be incorporated into a core outcome set reported in all HD trials. METHODS In an international online survey, participants rated the absolute importance of 10 cardiovascular outcomes (derived from a systematic review) on a 9-point Likert scale, with 7-9 being critically important. The relative importance was determined using a best-worst scale. Likert means, medians and proportions and best-worst preference scores were calculated for each outcome. Comments were thematically analyzed. RESULTS Participants included 127 (19%) patients/caregivers and 549 (81%) HPs from 53 countries, of whom 530 (78%) completed the survey in English and 146 (22%) in Chinese. All but one cardiovascular outcome ('valve replacement') was rated as critically important (Likert 7-9) by all participants; 'sudden cardiac death', 'heart attack', 'stroke' and 'heart failure' were all rated at the top by patients/caregivers (median Likert score 9). Patients/caregivers ranked the same four outcomes as the most important outcomes with mean preference scores of 6.2 (95% confidence interval 4.8-7.5), 5.9 (4.6-7.2), 5.3 (4.0-6.6) and 4.9 (3.6-6.3), respectively. The same four outcomes were ranked most highly by HPs. We identified five themes underpinning the prioritization of outcomes: 'clinical equipoise and potential for intervention', 'specific or attributable to HD', 'severity or impact on the quality of life', 'strengthen knowledge and education', and 'inextricably linked burden and risk'. CONCLUSIONS Patients and HPs believe that all cardiovascular outcomes are of critical importance but consistently identify sudden cardiac death, myocardial infarction, stroke and heart failure as the most important outcomes to be measured in all HD trials.
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Affiliation(s)
- Emma O'Lone
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Martin Howell
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia
| | - Jonathan C Craig
- College of Medicine and Health, Flinders University, Adelaide, SA, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Benedicte Sautenet
- Department of Nephrology and Clinical Immunology, Tours University, Tours, France.,Department of Nephrology-Hypertension, Dialysis, Renal Transplantation, Tours Hospital, Tours, France.,INSERM U1246, Tours, France
| | - William G Herrington
- Nuffield Department of Population Health, University of Oxford, Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Oxford, UK
| | - Charles A Herzog
- Department of Medicine, Division of Cardiology, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA
| | - Tazeen H Jafar
- Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore.,Department of Renal Medicine, Singapore General Hospital, Singapore.,Department of Medicine, Section of Nephrology, Aga Khan University, Karachi, Pakistan
| | - Meg Jardine
- George Institute for Global Health, Sydney, NSW, Australia.,Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Vera Krane
- Department of Medicine I, Division of Nephrology, University Hospital, Würzburg, Germany
| | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, BC, Canada
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Medicine Warsaw Medical University, Warsaw, Poland
| | - Michael V Rocco
- Wake Forest School of Medicine, Section on Nephrology, Winston-Salem, NC, USA
| | - Giovanni Strippoli
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia.,Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.,Medical Scientific Office, Diaverum Sweden AB, Lund, Sweden.,Diaverum Academy, Bari, Italy
| | - Marcello Tonelli
- Department of Medicine, Division of Nephrology, University of Calgary, Calgary, AB, Canada
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, PR China
| | - Christoph Wanner
- Department of Medicine I, Division of Nephrology, University Hospital, Würzburg, Germany
| | - Faiez Zannad
- Université de Lorraine, Inserm CIC 1433 and INI-CRCT, CHU, Nancy, France
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, TX, USA
| | - David C Wheeler
- Department of Renal Medicine, University College London, London, UK
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18
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Burlacu A, Genovesi S, Basile C, Ortiz A, Mitra S, Kirmizis D, Kanbay M, Davenport A, van der Sande F, Covic A. Coronary artery disease in dialysis patients: evidence synthesis, controversies and proposed management strategies. J Nephrol 2020; 34:39-51. [PMID: 32472526 DOI: 10.1007/s40620-020-00758-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/23/2020] [Indexed: 12/31/2022]
Abstract
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality among patients with end-stage renal disease (ESRD). Clustering of traditional atherosclerotic and non-traditional risk factors drive the excess rates of coronary and non-coronary CVD in this population. The incidence, severity and mortality of coronary artery disease (CAD) as well as the number of complications of its therapy is higher in dialysis patients than in non-chronic kidney disease patients. Given the lack of randomized clinical trial evidence in this population, current practice is informed by observational data with a significant potential for bias. Furthermore, guidelines lack any recommendation for these patients or extrapolate them from trials performed in non-dialysis patients. Patients with ESRD are more likely to be asymptomatic, posing a challenge to the correct identification of CAD, which is essential for appropriate risk stratification and management. This may lead to "therapeutic nihilism", which has been associated with worse outcomes. Here, the ERA-EDTA EUDIAL Working Group reviews the diagnostic work-up and therapy of chronic coronary syndromes, unstable angina/non-ST elevation and ST-elevation myocardial infarction in dialysis patients, outlining unclear issues and controversies, discussing recent evidence, and proposing management strategies. Indications of antiplatelet and anticoagulant therapies, percutaneous coronary intervention and coronary artery bypass grafting are discussed. The issue of the interaction between dialysis session and myocardial damage is also addressed.
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Affiliation(s)
- Alexandru Burlacu
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, and 'Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Simonetta Genovesi
- Nephrology Unit, San Gerardo Hospital, Monza, Italy, University of Milan-Bicocca, Milan, Italy
| | - Carlo Basile
- Division of Nephrology, Miulli General Hospital, Via Battisti 192, Acquaviva delle Fonti, 74121, Taranto, Italy. .,Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy.
| | - Alberto Ortiz
- FRIAT and REDINREN, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
| | - Sandip Mitra
- Manchester Academy of Health Sciences Centre, Manchester University Hospitals Foundation Trust and University of Manchester, Oxford Road, Manchester, UK
| | | | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
| | - Andrew Davenport
- Division of Medicine, UCL Centre for Nephrology, Royal Free Hospital, University College London, London, UK
| | - Frank van der Sande
- Division of Nephrology, Department of Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center-'C.I. Parhon' University Hospital, and 'Grigore T. Popa' University of Medicine, Iasi, Romania.,The Academy of Romanian Scientists (AOSR), Bucharest, Romania
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19
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Levi A, Simard T, Glover C. Coronary Artery Disease in patients with End-Stage Kidney Disease; Current perspective and gaps of knowledge. Semin Dial 2020; 33:187-197. [PMID: 32449824 DOI: 10.1111/sdi.12886] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 04/27/2020] [Indexed: 01/19/2023]
Abstract
Coronary artery disease (CAD) is very common in dialysis patients. One third have preexisting CAD and another one third have significant occult disease at the time of starting dialysis. Symptoms are often absent or are atypical, emphasizing the need for vigorous screening, specifically in patients awaiting transplant. The lesions tend to be heavily calcified, diffuse, and involve multiple vessels, consequently, percutaneous coronary interventions are more complicated to perform, and are less successful in achieving and maintaining short- and long-term patency. Dialysis patients have been excluded from the randomized controlled trials on which the current standards for managing CAD have been established. Due to differences in pathobiology and risks and benefits, it is uncertain that the results of these clinical trials extrapolate to patients with advanced chronic kidney disease (CKD). Here we review the data from observational studies and identify special considerations concerning the diagnosis and management of CAD in dialysis patients, including the use of noninvasive functional testing vs anatomical testing, the management of acute coronary syndromes and of stable coronary artery disease, the role for percutaneous revascularization vs coronary artery bypass grafting, and of platelet inhibitor therapy after coronary stenting. We review the preliminary results of the recently published ISCHEMIA-CKD trial, the only trial to date to involve large numbers of dialysis patients. This is the first of, hopefully, many trials in the pipeline that will examine therapies for CAD specifically in patients with advanced CKD, a growing population that is at particularly high risk for poor outcomes.
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Affiliation(s)
- Amos Levi
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Trevor Simard
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Christopher Glover
- University of Ottawa Heart Institute, Ottawa, ON, Canada.,Rabin Medical Center, Tel-Aviv University, Tel-Aviv, Israel
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20
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Outcomes of Renal Transplant Recipients after Percutaneous Coronary Intervention. Am J Cardiol 2020; 125:1305-1311. [PMID: 32139159 DOI: 10.1016/j.amjcard.2020.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/30/2020] [Accepted: 02/04/2020] [Indexed: 11/21/2022]
Abstract
Renal transplantation (RT) can improve life expectancy in hemodialysis (HD) patients. However, little is known about the outcomes of renal transplant recipients after percutaneous coronary intervention (PCI). This study aimed to elucidate the effect of RT on clinical outcomes after PCI. Renal transplant recipients who underwent PCI from 2002 to 2017 were enrolled. To evaluate the effectiveness of RT, we retrospectively reviewed HD patients who underwent PCI. Propensity-score matching was performed using logistic regression to control for differences in baseline characteristics. The primary outcome was the incidence of major adverse cardiac events. After propensity matching, patients were classified into the RT (n = 50) group and HD (n = 50) group. Kaplan-Meier analysis revealed that the incidence of major adverse cardiac events was significantly lower in the RT group than in the HD group (p < 0.0001). Moreover, RT was associated with a lower risk for all-cause death (odds ratio 0.04; 95% confidence interval 0.002 to 0.03; p = 0.0054) and target vessel revascularization (OR 0.27; 95% CI 0.07 to 0.79; p = 0.015). RT may improve clinical outcomes after PCI, and it is encouraged for HD patients to increase life expectancy and reduce the occurrence of adverse events after PCI. Further research would be warranted to support this finding.
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21
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Bagai A, Lu D, Lucas J, Goyal A, Herzog CA, Wang TY, Goodman SG, Roe MT. Temporal Trends in Utilization of Cardiac Therapies and Outcomes for Myocardial Infarction by Degree of Chronic Kidney Disease: A Report From the NCDR Chest Pain-MI Registry. J Am Heart Assoc 2019; 7:e010394. [PMID: 30514137 PMCID: PMC6405599 DOI: 10.1161/jaha.118.010394] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background We sought to determine temporal trends in use of evidence‐based therapies and clinical outcomes among myocardial infarction (MI) patients with chronic kidney disease (CKD). Methods and Results MI patients from the NCDR (National Cardiovascular Data Registry) Chest Pain–MI Registry between January 2007 and December 2015 were categorized into 3 groups by degree of CKD (end‐stage renal disease on dialysis, CKD [glomerular filtration rate <60 mL/min per 1.73 m2] not requiring dialysis, and no CKD [glomerular filtration rate ≥60 mL/min per 1.73 m2]). Logistic regression modeling was used to determine the association between calendar years (2014–2015 versus 2007–2008) and each outcome by degree of CKD. Among 325 396 patients with ST‐segment–elevation MI, 1.0% had end‐stage renal disease requiring dialysis, and 26.1% had CKD not requiring dialysis. Use of primary percutaneous coronary intervention increased over time regardless of the presence or degree of CKD (P=0.40 for interaction). In‐hospital mortality was temporally higher among patients with preserved renal function (odds ratio: 1.25; 95% confidence interval, 1.13–1.39; P<0.001) but not among patients with CKD (P=0.035 for interaction). Among 506 876 non–ST‐segment–elevation MI patients, 3.4% had end‐stage renal disease requiring dialysis, and 34.4% had CKD not requiring dialysis. P2Y12 inhibitor use within 24 hours increased over time only among dialysis patients (P for interaction <0.001). Use of coronary angiography and percutaneous coronary intervention also increased, with the greatest increase among dialysis patients (P for interaction <0.001 and <0.001, respectively). In‐hospital mortality was lower, regardless of the presence or degree of CKD (P=0.64 for interaction). Conclusions Uptake of evidence‐based medical and invasive therapies has increased over the past decade among MI patients with CKD, particularly dialysis patients, with improvement of in‐hospital mortality observed among patients with non–ST‐segment–elevation MI, but not ST‐segment–elevation MI, and CKD. See Editorial by Hira
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Affiliation(s)
- Akshay Bagai
- 1 Terrence Donnelly Heart Center St. Michael's Hospital University of Toronto Ontario Canada
| | - Di Lu
- 2 Division of Cardiology Duke University Medical Center Duke Clinical Research Institute Durham NC
| | - Joseph Lucas
- 2 Division of Cardiology Duke University Medical Center Duke Clinical Research Institute Durham NC
| | - Abhinav Goyal
- 3 Department of Medicine Emory University School of Medicine Atlanta GA
| | - Charles A Herzog
- 4 Chronic Disease Research Group Minneapolis Medical Research Foundation and Department of Medicine Hennepin County Medical Center University of Minnesota Minneapolis MN
| | - Tracy Y Wang
- 2 Division of Cardiology Duke University Medical Center Duke Clinical Research Institute Durham NC
| | - Shaun G Goodman
- 1 Terrence Donnelly Heart Center St. Michael's Hospital University of Toronto Ontario Canada
| | - Matthew T Roe
- 2 Division of Cardiology Duke University Medical Center Duke Clinical Research Institute Durham NC
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22
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Szummer K, Lindhagen L, Evans M, Spaak J, Koul S, Åkerblom A, Carrero JJ, Jernberg T. Treatments and Mortality Trends in Cases With and Without Dialysis Who Have an Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2019; 12:e005879. [DOI: 10.1161/circoutcomes.119.005879] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Patients on dialysis who have an acute myocardial infarction (AMI) have an exceedingly poor prognosis, but it is unknown to what extent guideline-recommended interventions and treatments are used and to which benefit. We aimed to assess temporal changes in the use of treatments and survival rates in dialysis patients with an AMI.
Methods and Results:
All consecutive AMI cases from 1996 to 2013 enrolled in the SWEDEHEART registry (Swedish Web–System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) were included. The Swedish Renal Registry identified all chronic dialysis cases. Multivariable adjusted standardized 1-year mortality was estimated. An age-sex-calendar year–matched dialysis background population from the Swedish Renal Registry was used to obtain a standardized incidence ratio. All analyses were performed in 2-year blocks, where each individual could be included several times but in different time blocks; hence the term AMI cases and not patients is used. Of 289 699 cases with AMI, 1398 (0.5%) were on dialysis (73.6% hemodialysis; 26.4% peritoneal dialysis). Among dialysis cases, 29.4% were women, and 21.0% had ST-segment–elevation myocardial infarction. Through 1996 to 2013, dialysis cases had similar age (median, 70 years [interquartile range, 62–77];
P
for trend, 0.14), but the proportion with diabetes mellitus increased (36.0%–55.3%;
P
for trend, 0.005). Dialysis cases admitted with AMI were treated more invasively and received more discharge medications in the later years. From 1995 to 2013, in-hospital and 1-year mortality decreased from 25.4% to 9.4% and from 59.6% to 41.2%, respectively. The standardized in-hospital and 1-year mortality decreased from 25.7% to 9.4% and from 54.6% to 41.2%. Yet, compared with the matched dialysis population, the odds of death remained as high in 2012/2013 as in 1996/1997 (odds ratio, 2.04; 95% CI, 1.62–2.58 and odds ratio, 1.99; 95% CI, 1.52–2.60, respectively;
P
for trend, 0.34).
Conclusions:
Over the last 18 years, more patients on dialysis with AMI have been treated with evidence-based therapies. Overall, dialysis cases with AMI have an improved in-hospital and 1-year survival in the more recent years compared with earlier years. However, this appears largely to be because of improved survival in the general dialysis population.
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Affiliation(s)
- Karolina Szummer
- Department of Cardiology (MedH), Karolinska Institutet, Stockholm, Sweden (K.S.)
- Department of Medicine (K.S.), Karolinska Institutet, Stockholm, Sweden
| | | | - Marie Evans
- Division of Renal Medicine, CLINTEC (Department of Clinical Science, Intervention and Technology), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden (M.E.)
| | - Jonas Spaak
- Department of Clinical Sciences, Danderyd University Hospital (J.S., T.J.), Karolinska Institutet, Stockholm, Sweden
| | - Sasha Koul
- Department of Cardiology, Lund University, Skåne University Hospital, Lund, Sweden (S.K.)
| | - Axel Åkerblom
- Department of Medical Sciences, Division of Cardiology, Uppsala Clinical Research Center, Uppsala University, Sweden (A.Å.)
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics (J.J.C.), Karolinska Institutet, Stockholm, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital (J.S., T.J.), Karolinska Institutet, Stockholm, Sweden
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23
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Klein EC, Kapoor R, Lewandowski D, Mason PJ. Revascularization Strategies in Patients with Chronic Kidney Disease and Acute Coronary Syndromes. Curr Cardiol Rep 2019; 21:113. [PMID: 31471758 DOI: 10.1007/s11886-019-1213-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW Chronic kidney disease (CKD) is a highly prevalent condition that increases the incidence and complexity of acute coronary syndrome (ACS). The purpose of this review is to summarize current evidence, uncertainties, and opportunities in the management of patients with CKD and ACS, with a focus on revascularization. RECENT FINDINGS Patients with CKD have been systematically under-represented or excluded from clinical trials in ACS. Available data, however, demonstrates that although patients with CKD and ACS benefit from revascularization, they are also less likely to receive recommended medical and revascularization therapies when compared to patients with normal kidney function. Despite the increased short-term risk of major morbidity and mortality, patients with CKD and ACS should be considered for an early invasive strategy while also trying to mitigate the risks of procedural related complications. Until evidence emerges from randomized clinical trials, the decision about revascularization strategy should involve multi-disciplinary collaboration, heart team consensus, and patient shared decision-making.
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Affiliation(s)
- Evan C Klein
- Medical College of Wisconsin, Milwaukee, WI, USA
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24
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Numasawa Y, Inohara T, Ishii H, Yamaji K, Hirano K, Kohsaka S, Sawano M, Kuno T, Kodaira M, Uemura S, Kadota K, Amano T, Nakamura M. An overview of percutaneous coronary intervention in dialysis patients: Insights from a Japanese nationwide registry. Catheter Cardiovasc Interv 2018; 94:E1-E8. [PMID: 30467967 DOI: 10.1002/ccd.27986] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 10/17/2018] [Accepted: 10/29/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study sought to provide an overview of percutaneous coronary intervention (PCI) in dialysis patients from a Japanese nationwide registry. BACKGROUND Little is known about dialysis patients undergoing PCI because few are enrolled in clinical trials. METHODS We analyzed 624,900 PCI cases including 41,384 dialysis patients (6.6%) from 1,017 Japanese hospitals between 2014 and 2016. We investigated differences in characteristics and in-hospital outcomes between dialysis and nondialysis patients, and assessed factors associated with an increased risk of adverse outcomes. RESULTS Dialysis patients had more comorbidities than nondialysis patients and higher rates of complications including in-hospital mortality (3.3% vs. 1.5%, respectively, in the acute coronary syndrome [ACS] cohort, 0.2% vs. 0.1% in the non-ACS cohort) and bleeding complications requiring blood transfusion (1.1% vs. 0.4% in ACS, 0.5% vs. 0.2% in non-ACS). Dialysis was significantly associated with an increased risk of in-hospital mortality (odds ratio [OR]: 1.42, 95% confidence interval [CI]: 1.24-1.62 in ACS, OR: 2.25, 95% CI: 1.66-3.05 in non-ACS) and bleeding (OR: 1.60, 95% CI: 1.30-1.96 in ACS, OR: 1.55, 95% CI: 1.27-1.88 in non-ACS). For dialysis patients, age, acute heart failure, and cardiogenic shock were associated with an increased risk of in-hospital mortality in the ACS cohort, whereas age, female gender, and history of heart failure were associated with higher in-hospital mortality in the non-ACS cohort. CONCLUSIONS PCI was widely performed for dialysis patients with either ACS or non-ACS in Japan. Dialysis patients had a greater risk of adverse outcomes than nondialysis patients after PCI.
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Affiliation(s)
- Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Taku Inohara
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.,Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kyohei Yamaji
- Division of Cardiology, Kokura Memorial Hospital, Japan
| | - Keita Hirano
- Department of Nephrology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Toshiki Kuno
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Masaki Kodaira
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
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25
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Marcolino MS, Oliveira JADQ, Silva GKME, Dias TD, Marino BCA, Antunes AP, Ribeiro AL, Cardoso CS. Satisfaction of Emergency Physicians with the Care Provided to Patients with Cardiovascular Diseases in the Northern Region of Minas Gerais. Arq Bras Cardiol 2018; 111:151-159. [PMID: 30183981 PMCID: PMC6122911 DOI: 10.5935/abc.20180143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/26/2018] [Accepted: 04/11/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The dissatisfaction of health professionals in emergency services has a negative influence on both the quality of care provided for acute myocardial infarction (AMI) patients and the retention of those professionals. OBJECTIVE To assess physicians' satisfaction with the structure of care and diagnosis at the emergency services in the Northern Region of Minas Gerais before the implementation of the AMI system of care. METHODS This cross-sectional study included physicians from the emergency units of the ambulance service (SAMU) and level II, III and IV regional hospitals. Satisfaction was assessed by using the CARDIOSATIS-Team scale. The median score for each item, the overall scale and the domains were calculated and then compared by groups using the non-parametric Mann-Whitney test. Correlation between time since graduation and satisfaction level was assessed using Spearman correlation. A p value < 0.05 was considered significant. RESULTS Of the 137 physicians included in the study, 46% worked at SAMU. Most of the interviewees showed overall dissatisfaction with the structure of care, and the median score for the overall scale was 2.0 [interquartile range (IQR) 2.0-4.0]. Most SAMU physicians expressed their dissatisfaction with the care provided (54%), the structure for managing cardiovascular diseases (52%), and the technology available for diagnosis (54%). The evaluation of the overall satisfaction evidenced that the dissatisfaction of SAMU physicians was lower when compared to that of hospital emergency physicians. Level III/IV hospital physicians expressed greater overall satisfaction when compared to level II hospital physicians. CONCLUSION This study showed the overall dissatisfaction of the emergency physicians in the region assessed with the structure of care for cardiovascular emergencies.
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Affiliation(s)
- Milena Soriano Marcolino
- Telehealth Center, University Hospital, Universidade Federal de
Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
- Medical School, Universidade Federal de Minas Gerais, Belo
Horizonte, MG - Brazil
| | - João Antonio de Queiroz Oliveira
- Telehealth Center, University Hospital, Universidade Federal de
Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
- Medical School, Universidade Federal de Minas Gerais, Belo
Horizonte, MG - Brazil
| | - Grace Kelly Matos e Silva
- Telehealth Center, University Hospital, Universidade Federal de
Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | - Thatiane Dantas Dias
- Telehealth Center, University Hospital, Universidade Federal de
Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | - Barbara Campos Abreu Marino
- Telehealth Center, University Hospital, Universidade Federal de
Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | | | - Antonio Luiz Ribeiro
- Telehealth Center, University Hospital, Universidade Federal de
Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
- Medical School, Universidade Federal de Minas Gerais, Belo
Horizonte, MG - Brazil
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26
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Akashi N, Sakakura K, Watanabe Y, Noguchi M, Taniguchi Y, Yamamoto K, Wada H, Momomura SI, Fujita H. The comparison of clinical outcomes in patients with acute myocardial infarction and advanced chronic kidney disease on chronic hemodialysis versus off hemodialysis. Heart Vessels 2018; 33:713-721. [DOI: 10.1007/s00380-018-1122-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/12/2018] [Indexed: 01/18/2023]
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27
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Chung CM, Lin MS, Chang CH, Cheng HW, Chang ST, Wang PC, Chang HY, Lin YS. Moderate to high intensity statin in dialysis patients after acute myocardial infarction: A national cohort study in Asia. Atherosclerosis 2017; 267:158-166. [DOI: 10.1016/j.atherosclerosis.2017.09.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/10/2017] [Accepted: 09/14/2017] [Indexed: 01/17/2023]
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28
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Howard CE, McCullough PA. Decoding Acute Myocardial Infarction among Patients on Dialysis. J Am Soc Nephrol 2017; 28:1337-1339. [DOI: 10.1681/asn.2017030226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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29
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Shroff GR, Li S, Herzog CA. Trends in Discharge Claims for Acute Myocardial Infarction among Patients on Dialysis. J Am Soc Nephrol 2017; 28:1379-1383. [PMID: 28220031 PMCID: PMC5407723 DOI: 10.1681/asn.2016050560] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Analysis of a contemporary cohort of patients on dialysis revealed that mortality from acute myocardial infarction (AMI) has decreased, whereas the prevalence of AMI has increased markedly, particularly among patients with non-ST elevation myocardial infarction (NSTEMI). Using inpatient discharge diagnosis codes (1993-2008), we determined that proportions of AMI claims decreased in the primary position (from 65% to 52%) but increased in the secondary position (from 35% to 48%). Proportions of NSTEMI codes increased remarkably in both the primary and secondary positions. The progressive increase in diagnostic claims for secondary AMI identifies a unique high-risk population and has important clinical, economic, and epidemiologic implications among patients on dialysis.
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Affiliation(s)
- Gautam R Shroff
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota; and
| | - Shuling Li
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Charles A Herzog
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota; and
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
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30
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Lingel JM, Srivastava MC, Gupta A. Management of coronary artery disease and acute coronary syndrome in the chronic kidney disease population-A review of the current literature. Hemodial Int 2017; 21:472-482. [DOI: 10.1111/hdi.12530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Justin M. Lingel
- Department of Internal Medicine, University of Maryland Medical Center; Baltimore MD
| | - Mukta C. Srivastava
- Division of Cardiovascular Medicine, University of Maryland School of Medicine; Baltimore MD
| | - Anuj Gupta
- Division of Cardiovascular Medicine, University of Maryland School of Medicine; Baltimore MD
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FSTL1 as a Potential Mediator of Exercise-Induced Cardioprotection in Post-Myocardial Infarction Rats. Sci Rep 2016; 6:32424. [PMID: 27561749 PMCID: PMC5000295 DOI: 10.1038/srep32424] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 08/05/2016] [Indexed: 12/26/2022] Open
Abstract
Exercise training has been reported to ameliorate heart dysfunction in both humans and animals after myocardial infarction (MI), but the underlying mechanisms are poorly understood. Follistatin-like1 (FSTL1) is a cardioprotective factor against ischemic injury and is induced in cardiomyocytes and skeletal muscle in ischemic and hypoxic conditions. To test the hypothesis that FSTL1 may be a molecular link between exercise and improved heart function post MI, we subjected MI-rats, induced by left coronary artery ligation, to two modes of exercise: intermittent aerobic exercise (IAE) or mechanical vibration training (MVT), for four weeks and examined the relevance of FSTL1 to exercise-mediated cardiac effects. Exercise improved the functional performance, reduced fibrosis of MI-hearts and induced FSTL1 expression, the TGFβ-Smad2/3 signaling and angiogenesis in myocardium. In gastrocnemius, exercise increased the cross-sectional area of myocytes and FSTL1 expression. Importantly, exercise increased circulating FSTL1 levels, which were positively correlated with the skeletal muscle FSTL1 expression and negatively correlated with heart fibrosis. Overall, the IAE was more effective than that of MVT in cardioprotection. Finally, exogenous FSTL1 administration directly improved angiogenesis as well as functionality of post-MI hearts. Taken together, we have demonstrated that FSTL1 is a potential mediator of exercise-induced cardioprotection in post-MI rats.
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32
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Shroff GR, Herzog CA. Coronary Revascularization in Patients with CKD Stage 5D: Pragmatic Considerations. J Am Soc Nephrol 2016; 27:3521-3529. [PMID: 27493258 DOI: 10.1681/asn.2016030345] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Coronary revascularization decisions for patients with CKD stage 5D present a dilemma for clinicians because of high baseline risks of mortality and future cardiovascular events. This population differs from the general population regarding characteristics of coronary plaque composition and behavior, accuracy of noninvasive testing, and response to surgical and percutaneous revascularization, such that findings from the general population cannot be automatically extrapolated. However, this high-risk population has been excluded from all randomized trials evaluating outcomes of revascularization. Observational studies have attempted to address long-term outcomes after surgical versus percutaneous revascularization strategies, but inherent selection bias may limit accuracy. Compared with percutaneous strategies, surgical revascularization seems to have long-term survival benefit on the basis of observational data but associates with substantially higher short-term mortality rates. Percutaneous revascularization with drug-eluting and bare metal stents associates with a high risk of in-stent restenosis and need for future revascularization, perhaps contributing to the higher long-term mortality hazard. Off-pump coronary bypass surgery and the newest generation of drug-eluting stent platforms offer no definitive benefits. In this review, we address the nuances, complexities, and tradeoffs that clinicians face in determining the optimal method of coronary revascularization for this high-risk population.
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Affiliation(s)
- Gautam R Shroff
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota; and
| | - Charles A Herzog
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota; and .,Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
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33
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Vichova T, Knot J, Ulman J, Maly M, Motovska Z. The impact of stage of chronic kidney disease on the outcomes of diabetics with acute myocardial infarction treated with percutaneous coronary intervention. Int Urol Nephrol 2016; 48:1137-43. [PMID: 26995007 DOI: 10.1007/s11255-016-1260-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 03/02/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Patients with diabetes mellitus (DM) or chronic kidney disease (CKD) have a high risk of acute myocardial infarction and recurrent cardiovascular events. According to the previous studies, the combination of the two conditions may have a synergistic impact on prognosis. The aim of this study was to assess the impact of stage of CKD on the outcomes of patients with DM and ST-elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI). METHODS Study population consisted of 946 consecutive patients with STEMI who underwent PCI from January 2009 to December 2012 and were followed up until the end of 2013. The all-cause mortality during this period was evaluated in relation to DM and severe or moderate reduction in glomerular filtration rate (GFR categories G4-5, or G3; KDIGO classification). Cox regression analysis adjusted for possible confounding factors was used in statistics. RESULTS Out of the study population (mean age 63 years, 69.6 % males), 217 (22.9 %) patients had DM. Of them, 10.6 % were in GFR category G4-5 and 32.7 % in G3. The in-hospital mortality rates in patients with DM were 34.8 % for G4-5, 18.3 % for G3, and 4.1 % in G1-2 groups. The all-cause mortality at the end of the follow-up period for diabetics within G4-5 was 2.27 -times higher compared to mortality of diabetics in G1-2 (p = 0.047, Cox regression analysis), and there was a trend toward higher mortality for G3 versus G1-2 (HR 1.64, p = 0.12). CONCLUSION Severe chronic kidney disease (GFR category 4-5) was significantly associated with all-cause mortality of diabetics with STEMI treated with PCI; the association with severe CKD was stronger compared to moderate CKD.
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Affiliation(s)
- Teodora Vichova
- Cardiocentre, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 10034, Prague, Czech Republic
| | - Jiri Knot
- Cardiocentre, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 10034, Prague, Czech Republic
| | - Jaroslav Ulman
- Cardiocentre, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 10034, Prague, Czech Republic
| | - Marek Maly
- Department of Biostatistics and Informatics, National Institute of Public Health, Srobarova 48, 10042, Prague, Czech Republic
| | - Zuzana Motovska
- Cardiocentre, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 10034, Prague, Czech Republic.
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34
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Shroff GR, Li S, Herzog CA. Trends in Mortality Following Acute Myocardial Infarction Among Dialysis Patients in the United States Over 15 Years. J Am Heart Assoc 2015; 4:e002460. [PMID: 26459933 PMCID: PMC4845120 DOI: 10.1161/jaha.115.002460] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 08/13/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND We sought to determine 15-year trends in mortality rates among dialysis patients with acute myocardial infarction (AMI) in the contemporary era. METHODS AND RESULTS Using 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). CONCLUSIONS In-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.
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Affiliation(s)
- Gautam R Shroff
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN (G.R.S., C.A.H.)
| | - Shuling Li
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN (S.L., C.A.H.)
| | - Charles A Herzog
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN (G.R.S., C.A.H.) Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN (S.L., C.A.H.)
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