Underutilization of left heart catheterization in kidney transplant patients presenting with non-ST segment elevation
Ahmad Mustafa1,2, Samer Asmar1, Chapman Wei1
1Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA.
Insights
Kidney transplant patients with heart attack symptoms underwent fewer heart procedures. Coronary angiography significantly reduced mortality and complications, suggesting benefits outweigh perceived risks.
Area of Science:
- Nephrology
- Cardiology
- Transplant Medicine
Background:
- Cardiovascular disease is a primary cause of death in kidney transplant recipients.
- Fear of contrast-induced nephropathy may deter necessary coronary angiography in these patients.
Purpose of the Study:
- To investigate the utilization and outcomes of coronary angiography in kidney transplant patients presenting with non-ST segment elevation myocardial infarction.
- To compare the safety and efficacy of left heart catheterization in kidney transplant versus non-kidney transplant patients.
Main Methods:
- Utilized the National Inpatient Sample (NIS) database for patients with non-ST segment elevation myocardial infarction.
- Stratified patients into kidney transplant (KT) and non-KT cohorts.
- Employed propensity matching and regression analyses to compare outcomes including mortality, arrhythmias, acute kidney injury/acute renal failure (AKI/ARF), and extended length of hospital stay (ELOS).
Main Results:
- Kidney transplant patients were less likely to undergo left heart catheterization (LHC) compared to non-kidney transplant patients.
- Among patients who underwent LHC, kidney transplant recipients showed significantly lower rates of mortality, AKI/ARF, arrhythmias, and ELOS.
- Post-match analysis confirmed reduced risk of arrhythmias, AKI/ARF, and ELOS in kidney transplant patients who received LHC.
Conclusions:
- Kidney transplant patients undergo coronary angiography less frequently for non-ST segment elevation myocardial infarction.
- Coronary angiography and revascularization are associated with improved outcomes, including reduced morbidity and mortality.
- The potential risk of contrast-induced nephropathy should not preclude kidney transplant patients from receiving beneficial left heart catheterization.
Background:
Cardiovascular disease (CVD) is the leading cause of mortality in kidney transplant (KT) patients. The perceived risk of contrast-induced nephropathy (CIN) may create a reluctance to perform coronary angiography in patients presenting with non-ST segment elevation myocardial infarction (NSTEMI).
Methods:
National Inpatient Sample (NIS) Database was used to sample individuals presenting with NSTEMI. Patients were stratified into KT and Non-KT cohorts. Outcomes included left heart catheterization rates, mortality, arrhythmias, acute kidney injury/acute renal failure (AKI/ARF), and extended length of hospital stay (ELOS) (>72 h). Propensity matching (1:1 ratio) and regression analyses were performed.
Results:
Out of 336,354 patients with NSTEMI, 742 patients were in the KT group. KT patients were less likely to have LHC relative to non-KT patients (22.0 % vs 18.3 %); a difference that persisted on post-match analysis (27.1 % vs 19.4 %). On pre-match analysis, KT transplant patients that underwent LHC had lower mortality (10.3 % vs 0.7 %), AKI/ARF (44.6 % vs 27.9 %), arrhythmias (30.4 % vs 20.6 %) and lower ELOS (58.6 % vs 41.9 %). Post-match, KT cohort patient that underwent LHC had lower arrhythmias (OR:0.60[0.38-0.96]), AKI/ARF (OR = 0.51[0.34-0.77]), ELOS (OR:0.49[0.34-0.73]).
Conclusion:
KT patients underwent LHC much less frequently than their non-KT counterparts for NSTEMI. Coronary angiography and subsequent revascularization were associated with a significant decrease in morbidity and mortality. This theorized risk of CIN should not outweigh the benefit of LHC in KT patients.
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