Key result
Dialysis-dependent patients with acute myocardial infarction had a significantly higher risk of 2-year all-cause mortality compared to patients with preserved renal function (HR 1.67).
Why the study?
Does dialysis dependence or nondialysis CKD worsen short- and long-term prognosis in patients with acute myocardial infarction compared to preserved renal function?
Cohort (n=158,125)
Does dialysis dependence or nondialysis CKD worsen short- and long-term prognosis in patients with acute myocardial infarction compared to preserved renal function?
Patients with AMI and CKD, particularly those dependent on dialysis, have significantly worse short- and long-term clinical outcomes, highlighting the need for intensive management in this high-risk population.
Answers are grounded in this paper and cite their sources.
Dialysis dependence was associated with higher post-AMI MI and mortality risks; extends CKD prognostic data but leaves optimal strategies open.
In this study we aimed to directly compare the short and long-term prognosis of nondialysis patients with chronic kidney disease (CKD), dialysis patients, and patients with preserved renal function after acute myocardial infarction (AMI).AMI in patients with CKD is a catastrophic event associated with high medical expenditures and dismal survival. However, there is little research comparing post-AMI outcomes between patients with CKD who were and were not receiving dialysis.The retrospective cohort study included patients with AMI (n = 158,125) in the Taiwan's National Health Insurance Research Database who were treated March 1998 and December 2009. Patients were classified into a nondialysis CKD group (n = 6300), dialysis group (n = 5140), and a control group (n = 146,685). The clinical characteristics, in-hospital events, and long-term outcomes of these 3 groups were compared separately using a multivariable Cox proportional hazard model.The risks of in-hospital death and 2-year all-cause mortality were the highest in the dialysis group, followed by the nondialysis CKD group, and were the lowest in the control group. The 1-year risk of myocardial infarction did not differ among the 3 study groups, but the 2-year risk of myocardial infarction was higher in the dialysis group than in the control group (hazard ratio, 1.13; 95% confidence interval, 1.03-1.24; P = .010).Patients with CKD experienced adverse short- and long-term outcomes after acute myocardial infarction. Patients with CKD, especially those who are dialysis dependent, may require more intensive management to improve their post-AMI clinical outcomes.
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Fu et al. (2018) conducted a cohort in Acute myocardial infarction (n=158,125). Dialysis-dependent chronic kidney disease vs. Preserved renal function (control) was evaluated on 2-year all-cause mortality (HR 1.67, 95% CI 1.61-1.73, p=<.001). Dialysis-dependent patients with acute myocardial infarction had a significantly higher risk of 2-year all-cause mortality compared to patients with preserved renal function (HR 1.67).
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