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

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.