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ST elevation myocardial infarction and kidney transplant: A large cohort study: STEMI and renal transplant

Tanveer Mir1, Mohammed Uddin1, Asif Shah2

  • 1Internal Medicine, Detroit Medical Center Wayne State University, Detroit, MI, United States.

Journal of Cardiology
|September 27, 2021
PubMed

Insights

ST-elevation myocardial infarction (STEMI) is a significant complication in kidney transplant recipients (KTR), leading to higher mortality and mechanical complications. Improving cardiovascular risk factors may reduce STEMI incidence in this population.

Area of Science:

  • Cardiology
  • Nephrology
  • Transplantation Medicine

Background:

  • Limited literature exists on the outcomes of ST-elevation myocardial infarction (STEMI) specifically within the kidney transplant recipient (KTR) population.
  • STEMI represents a critical cardiovascular event with potentially distinct implications for KTR due to their unique physiological state.

Purpose of the Study:

  • To investigate the incidence, in-hospital outcomes, and complications associated with STEMI among kidney transplant recipients (KTR).
  • To evaluate the impact of percutaneous coronary intervention (PCI) on mortality in KTR experiencing STEMI.

Main Methods:

  • Analysis of the National Readmissions Database (NRD) from 2012-2018, including 588,668 KTR hospitalizations.
  • Extraction of STEMI cases and associated complications using International Classification of Diseases codes.
  • Utilized coarsened exact matching to assess the association between PCI and mortality.

Main Results:

  • STEMI occurred in 0.59% of KTR hospitalizations, with significantly higher in-hospital mortality (13.3%) compared to non-STEMI cases (1.92%).
  • STEMI patients experienced increased rates of mechanical complications, cardiogenic shock, ventricular arrhythmias, conduction blocks, stroke, and acute kidney injury.
  • Percutaneous coronary intervention (PCI) was associated with reduced mortality (OR 0.39; p=0.0002), while STEMI incidence decreased and PCI utilization increased over the study period.

Conclusions:

  • STEMI is a notable complication in KTR, frequently associated with severe mechanical complications and increased mortality.
  • While STEMI rates have shown a decreasing trend, proactive management of cardiovascular risk factors is crucial for mitigating STEMI incidence and improving outcomes in KTR.
Abstract

Keywords:
Coronary proceduresKidney transplant recipientsMechanical complicationsPercutaneous coronary interventionST-elevation myocardial infarction

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