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Sex Disparity in the In-Hospital Outcomes of Patients with Kidney Disease Admitted for Myocardial Infarction:
Frederick Berro Rivera1, Jade Monica Marie Ruyeras2, Wailea Faye C Salva2
1Department of Medicine, Lincoln Medical Center, New York, New York, USA.
Insights
Female patients with ST-elevation myocardial infarction (STEMI) and chronic kidney disease (CKD) have higher in-hospital mortality. Women with STEMI and end-stage renal disease (ESRD) received less revascularization and mechanical support.
Area of Science:
- Cardiology
- Nephrology
- Health Outcomes Research
Background:
- Limited evidence exists on sex-based outcome disparities in ST-elevation myocardial infarction (STEMI) patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD).
- Understanding these differences is crucial for targeted patient care and improved clinical strategies.
Purpose of the Study:
- To investigate sex-based differences in clinical outcomes for patients hospitalized with STEMI and concomitant CKD or ESRD.
- To identify potential disparities in treatment and mortality between male and female patients in these specific populations.
Main Methods:
- Utilized the National Inpatient Sample database, identifying STEMI patients with CKD or ESRD using ICD-9/10 codes from 2012-2020.
- Analyzed in-hospital mortality as the primary outcome, with secondary outcomes including stroke, bleeding, revascularization procedures, and mechanical support.
Main Results:
- Analyzed 1,283,255 STEMI patients without CKD, 158,715 with CKD, and 22,690 with ESRD.
- Female STEMI patients with CKD showed significantly higher in-hospital mortality (16.7% vs. 12.7%, aOR=1.13).
- Among STEMI patients with ESRD, females had no difference in mortality but received less coronary artery bypass grafting and mechanical circulatory support.
Conclusions:
- Female sex is associated with increased in-hospital mortality in STEMI patients with CKD.
- Females with STEMI and ESRD are less likely to receive critical interventions like coronary artery bypass grafting and mechanical circulatory support.
- Further research is warranted to elucidate the mechanisms behind these observed sex-based outcome disparities.
Introduction:
There is limited evidence as to the effect of sex on the outcomes of patients admitted for ST-elevation myocardial infarction (STEMI) who have a concomitant diagnosis of chronic kidney disease (CKD) and end-stage renal disease (ESRD). We aimed to determine if there are differences in the outcomes between males and females in these patient populations.
Methods:
Data were obtained from the National Inpatient Sample database and patients were selected using the International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and -10) codes. Hospitalizations for patients with CKD who had STEMI from 2012 to 2020 were included. The primary outcome of interest was in-hospital mortality. Secondary outcomes evaluated included ischemic stroke, major bleeding complications, pressor requirement, permanent pacemaker implantation, percutaneous coronary intervention, coronary artery bypass grafting, surgery, pericardiocentesis, mechanical circulatory support, and mechanical ventilation.
Results:
A total of 1,283,255 STEMI patients without CKD, 158,715 STEMI patients with CKD, and 22,690 STEMI patients with ESRD were identified and analyzed. Among patients with STEMI and CKD, females demonstrated higher in-hospital mortality compared to male counterparts (16.7% vs. 12.7%, aOR = 1.13, 95% CI: 1.05-1.21, p < 0.01). While there was no sex difference in the in-hospital mortality among STEMI patients with ESRD, female patients in this group were less likely to receive coronary artery bypass grafting and mechanical circulatory support.
Conclusion:
Increased in-hospital mortality rates were shown for females admitted for STEMI with CKD. Among patients with ESRD who had STEMI, females were less likely to receive coronary artery bypass grafting and mechanical circulatory support. Further research needs to be conducted to better explain this said difference in outcomes.
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