Affiliation:
1. Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN
2. Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN
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.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
38 articles.
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