Acute myocardial infarction in patients with end-stage renal disease

Ischemic heart disease is the major cause of death in dialysis patients, with 22% of cardiac deaths attributed to acute myocardial infarction (AMI). Few data exist on survival of dialysis patients after AMI.

The United States Renal Data System (USRDS) database of 627,983 patients was used to examine outcomes of dialysis patients hospitalized from 1977 to 1995 for AMI. Long-term survival was estimated by life-table method and independent predictors of survival were examined in a comorbidity-adjusted Cox model. In preliminary analyses we examined the utilization of thrombolytic therapy for AMI in 1991 to 1995 and separately analyzed outcomes of dialysis patients hospitalized 1977 to 1994 at our own institution.

There were 34,189 dialysis patients with AMI. The in-hospital death was 26%. The all-cause mortality was 59% at one year and 73% at two years. The one- and two-year cardiac mortality was 41% and 52%, respectively. Patients with AMI 1990 to 1995 (vs. 1977 to 1984) had decreased mortality with RR (relative risk) 0.87 (0.83, 0.90). There were 16,063 patients with AMI 1991 to 1995 receiving no reperfusion therapy, and only 95 patients received intravenous thrombolytics, of whom 16 received concurrent coronary revascularization. At our institution, the in-hospital death for 113 dialysis patients with AMI was 29% (52% mortality for transmural MI, 16% mortality for nontransmural MI).

We conclude that dialysis patients with AMI suffer dismal long-term survival. Based on preliminary data, thrombolytic therapy appears to be under-utilized in dialysis patients with AMI in the United States.