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Management and Outcomes of ST-Segment Elevation Myocardial Infarction in US Renal Transplant Recipients
Tanush Gupta1, Dhaval Kolte2, Sahil Khera3
1Division of Cardiology, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, New York2Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Insights
Renal transplant recipients with ST-segment elevation myocardial infarction (STEMI) have lower in-hospital mortality than those with stage 5D chronic kidney disease (CKD). Outcomes for transplant recipients approach those without CKD, highlighting improved care for these patients.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Transplantation Medicine
Background:
- Renal transplantation is known to reduce myocardial infarction (MI) risk in patients with stage 5D chronic kidney disease (CKD).
- Outcomes of MI in renal transplant recipients compared to patients with stage 5D CKD or no CKD are not well understood.
Purpose of the Study:
- To compare in-hospital reperfusion rates for ST-segment elevation MI (STEMI).
- To compare in-hospital outcomes of STEMI among renal transplant recipients, patients with stage 5D CKD, and those without CKD.
Main Methods:
- Utilized the National Inpatient Sample database (2003-2013) for STEMI hospitalizations in patients aged 18+.
- Classified patients into non-CKD, stage 5D CKD, or prior renal transplant groups using ICD-9-CM codes.
- Analyzed in-hospital mortality as the primary outcome measure.
Main Results:
- Renal transplant recipients received reperfusion more often than stage 5D CKD patients but less often than non-CKD patients.
- Risk-adjusted in-hospital mortality for renal transplant recipients with STEMI was significantly lower than stage 5D CKD patients.
- In-hospital mortality for renal transplant recipients was similar to the non-CKD group.
- Reperfusion rates increased over time in transplant recipients, while mortality remained stable.
Conclusions:
- In-hospital mortality rates for renal transplant recipients experiencing STEMI are more favorable than for patients with stage 5D CKD.
- STEMI outcomes in renal transplant recipients are comparable to those observed in the general population without CKD.
- These findings suggest improved management and outcomes for STEMI in renal transplant recipients.
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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