Faculty Collaboration Database

Recent Trends in Management and Inhospital Outcomes of Acute Myocardial Infarction in Renal Transplant Recipients. Am J Cardiol 2017 Feb 15;119(4):542-552

Date

12/13/2016

Pubmed ID

27939383

DOI

10.1016/j.amjcard.2016.10.041

Scopus ID

2-s2.0-85007574627 (requires institutional sign-in at Scopus site)   10 Citations

Abstract

Renal transplant recipients (RTR) are at high risk of cardiovascular events including acute myocardial infarction (AMI). We evaluated recent trends in AMI admissions in 9,243 RTR with functioning grafts using data from the 2003 to 2011 Nationwide Inpatient Sample database. Findings were compared with those of patients with end-stage renal disease without transplantation (ESRD-NRT, n = 160,932) and those without advanced kidney disease (non-ESRD/RT, n = 5,640,851) admitted with AMI. RTR comprised 0.2% of AMI admissions with increasing numbers during the study period (adjusted odds ratio [aOR] 1.04; 95% confidence interval [CI] 1.04 to 1.05; p_trend <0.001). Overall, 29.3% of admissions in RTR were for acute ST-segment elevation myocardial infarction (STEMI). Compared with non-ESRD/RT, history of renal transplantation was independently associated with a decreased likelihood of STEMI at presentation (aOR 0.73; 95% CI 0.65 to 0.80; p <0.001). Inhospital mortality among RTR admitted for NSTEMI decreased from 3.8% in 2003 to 2.1% in 2011 (aOR 0.85; 95% CI 0.78 to 0.93; p <0.001), whereas that for STEMI remained unchanged (7.6% in 2003; 9.3% in 2011, aOR 0.97; 95% CI 0.90 to 1.03; p = 0.36). Rates of percutaneous coronary interventions were higher, and inhospital mortality was lower among RTR compared with ESRD-NRT (p <0.001 for both). Treatment strategies appeared largely unchanged during the course of this study with the exception of an increase in primary percutaneous coronary intervention among RTR admitted with STEMI. In conclusion, RTR were frequently admitted with AMI, particularly NSTEMI, and were found to have multiple coronary artery disease risk factors despite their younger age. Compared with other forms of renal replacement therapy, renal transplant was associated with lower inhospital mortality.

Author List

Agrawal S, Garg L, Garg A, Mohananey D, Jain A, Manda Y, Singh A, Nanda S, Durkin R, Puleo P, Shirani J

Author

Divyanshu Mohananey MD Assistant Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Kidney Injury
Aged
Databases, Factual
Disease Management
Female
Gastrointestinal Hemorrhage
Hospital Mortality
Humans
Kidney Failure, Chronic
Kidney Transplantation
Male
Middle Aged
Myocardial Infarction
Non-ST Elevated Myocardial Infarction
Odds Ratio
Percutaneous Coronary Intervention
Postoperative Complications
Postoperative Hemorrhage
Renal Dialysis
Renal Insufficiency, Chronic
ST Elevation Myocardial Infarction