Key result
Hemodialysis predicts ~150% higher 6-year MACE risk in ACS, as does stent thrombosis etiology.
Why the study?
PCI in patients with ACS undergoing hemodialysis remains challenging, with limited long-term outcome data.
Does hemodialysis and stent thrombosis worsen major adverse cardiac events in patients with acute coronary syndrome?
Cohort (n=2,043)
Yes
Does hemodialysis and stent thrombosis worsen major adverse cardiac events in patients with acute coronary syndrome?
Answers are grounded in this paper and cite their sources.
Patients on hemodialysis presenting with ACS, particularly due to stent thrombosis, have highly unfavorable long-term prognoses with a 6-year MACE rate exceeding 80%.
Percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) undergoing hemodialysis (HD) remains challenging, with limited long-term outcome data. We investigated the long-term prognosis of ACS due to de novo coronary artery lesions and stent thrombosis (ST) in patients with and without HD. We analyzed 187 patients with ACS from the Osaka Cardiovascular Conference Long ST registry, a retrospective, multicenter registry of definite ST, and 1,856 patients with ACS due to de novo coronary artery lesions at Kansai Rosai Hospital. Patients were grouped by HD status and ACS etiology (de novo- and ST-ACS). The primary outcome was the 6-year incidence of major adverse cardiac events (MACE) defined as a composite of cardiac death, non-fatal myocardial infarction, target vessel revascularization, and subsequent ST. The 6-year MACE rate was highest in ST-ACS with HD, followed by de novo-ACS with HD, ST-ACS without HD, and de novo-ACS without HD (82.1 vs. 62.5 vs. 38.3 vs. 24.2%, respectively, p < 0.001). Multivariate analysis identified HD (hazard ratio [HR]: 2.50, 95% confidence interval [CI]: 1.89-3.32, p < 0.001) and ST-ACS (HR: 1.69, 95% CI: 1.17-2.45, p = 0.006) as independent MACE predictors. The long-term prognoses following ACS are unfavorable in patients on HD, particularly those with ST-ACS.
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Nakao et al. (2025) conducted a cohort in Acute coronary syndrome (n=2,043). Hemodialysis vs. Without hemodialysis was evaluated on 6-year incidence of major adverse cardiac events (MACE) defined as a composite of cardiac death, non-fatal myocardial infarction, target vessel revascularization, and subsequent ST (HR 2.50, 95% CI 1.89-3.32, p=<0.001). Hemodialysis (HR 2.50; 95% CI 1.89-3.32; P<0.001) and stent thrombosis etiology (HR 1.69; 95% CI 1.17-2.45; P=0.006) independently predicted 6-year MACE in patients with acute coronary syndrome.
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