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Original Investigation
March 2017

Management and Outcomes of ST-Segment Elevation Myocardial Infarction in US Renal Transplant Recipients

Author Affiliations
  • 1Division of Cardiology, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, New York
  • 2Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
  • 3Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
  • 4Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
  • 5Division of Cardiology, Ronald Reagan–UCLA (University of California, Los Angeles) Medical Center
  • 6Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
JAMA Cardiol. 2017;2(3):250-258. doi:10.1001/jamacardio.2016.5131
Key Points

Question  What are the differences in in-hospital reperfusion rates and outcomes of ST-segment elevation myocardial infarction among renal transplant recipients, patients without chronic kidney disease, or those with stage 5D chronic kidney disease?

Findings  In this retrospective nationwide analysis of approximately 2.3 million patients with ST-segment elevation myocardial infarction, renal transplant recipients were less likely to receive reperfusion compared with patients without chronic kidney disease, but had similar risk-adjusted in-hospital mortality. In contrast, compared with patients with stage 5D chronic kidney disease, renal transplant recipients were much more likely to receive reperfusion and had markedly lower in-hospital mortality rates.

Meaning  In-hospital mortality rates in renal transplant recipients with ST-segment elevation myocardial infarction are more favorable compared with those in patients with stage 5D chronic kidney disease and are similar to those in the general population.

Abstract

Importance  Renal transplantation is associated with reduction in the risk for myocardial infarction (MI) in patients with chronic kidney disease requiring long-term dialysis (stage 5D CKD). Whether outcomes of MI differ among renal transplant recipients vs patients with stage 5D CKD or those without CKD has not been well examined.

Objectives  To compare in-hospital reperfusion rates and outcomes of ST-segment elevation MI (STEMI) in renal transplant recipients vs the stage 5D CKD group or the non-CKD group.

Design, Setting, and Participants  The National Inpatient Sample database was queried to identify patients 18 years or older who were hospitalized with the principal diagnosis of STEMI. All hospitalizations for STEMI in the United States from January 1, 2003, to December 31, 2013, were included. Codes from International Classification of Diseases, Ninth Revision, Clinical Modification, were used to identify patients in the non-CKD, stage 5D CKD, or prior renal transplant groups. Data were analyzed from March to May 2016.

Main Outcomes and Measures  In-hospital mortality.

Results  From 2003 to 2013, 2 319 002 patients in the non-CKD group (34.7% women; 65.3% men; mean [SD] age, 64.2 [14.4] years), 30 072 patients in the stage 5D CKD group (45.0% women; 55.0% men; mean [SD] age, 66.9 [12.5] years), and 2980 patients in the renal transplant group (27.3% women; 72.7% men; mean [SD] age, 57.5 [11.1] years) were identified who were hospitalized with STEMI. Of these, 68.9% of the patients in the non-CKD group, 39.5% in the stage 5D CKD group, and 65.2% in the renal transplant group received in-hospital reperfusion for STEMI. The renal transplant group was more likely to receive reperfusion compared with the stage 5D CKD group (adjusted odds ratio [AOR], 1.83; 95% CI, 1.67-2.01; P < .001) but less likely compared with the non-CKD group (AOR, 0.75; 95% CI, 0.68-0.83; P < .001). Risk-adjusted in-hospital mortality among the renal transplant group with STEMI was markedly lower compared with the stage 5D CKD group (AOR, 0.37; 95% CI, 0.33-0.43; P < .001) but similar compared with the non-CKD group (AOR, 1.14; 95% CI, 0.99-1.31; P = .08). Among renal transplant recipients with STEMI, the use of reperfusion increased from 53.7% in the 2003-2004 interval to 81.4% in the 2011-2013 interval (AOR, 1.33; 95% CI, 1.25-1.43; P < .001 for trend), whereas risk-adjusted in-hospital mortality remained unchanged during the study period, from 8.9% in the 2003-2004 interval to 6.1% in the 2011-2013 interval (AOR, 0.94; 95% CI, 0.85-1.05; P = .27 for trend).

Conclusions and Relevance  In-hospital mortality rates in renal transplant recipients with STEMI are more favorable compared with those of patients with stage 5D CKD and approach those of the general population with STEMI.

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