Key result
Dialysis-dependent CKD linked to ~464% higher mortality versus normal renal function after STEMI.
Why the study?
Cardiovascular disease is often associated with chronic kidney disease, resulting in increased risk for poor outcomes in STEMI patients, but detailed prognosis by CKD stage was unclear.
How does the presence and severity of chronic kidney disease affect overall survival and the use of guideline-recommended therapies in patients with STEMI?
Cohort (n=175,187)
How does the presence and severity of chronic kidney disease affect overall survival and the use of guideline-recommended therapies in patients with STEMI?
Answers are grounded in this paper and cite their sources.
Advanced chronic kidney disease in STEMI patients is associated with significant underutilization of guideline-directed therapies and markedly decreased overall survival.
BACKGROUND: Cardiovascular disease is often associated with chronic kidney disease (CKD), resulting in an increased risk for poor outcome. We sought to determine short-term mortality and overall survival in ST-elevation myocardial infarction (STEMI) patients with different stages of CKD. METHODS: In our retrospective cohort study with health insurance claims data of the Allgemeine Ortskrankenkasse (AOK), anonymized data of all STEMI patients hospitalized between 2010 and 2017 were analyzed regarding presence and severity of concomitant CKD. RESULTS: A total of 175,187 patients had an index-hospitalisation for STEMI (without CKD: 78.6% patients, CKD stage 1: 0.8%, CKD stage 2: 4.8%, CKD stage 3: 11.7%, CKD stage 4: 2.8%, CKD stage 5: 0.7%, CKD stage 5d: 0.6%). Patients with CKD were older and had more co-morbidities than patients without CKD. With increasing CKD severity, patients received less revascularization therapies (91.2%, 85.9%, 87.0%, 81.8%, 71.7%, 76.9% and 78.6% respectively, p < 0.001). After 1 year, guideline-recommended medications were prescribed less frequently in advanced CKD (83.4%, 79.3%, 81.5%, 74.7%, 65.0%, 59.4% and 53.7%, respectively, p < 0.001). CKD stages 4, 5 and 5d as well as chronic limb threatening ischemia (CLTI) were associated with decreased overall survival [CKD stage 4: hazard ratio (HR) 1.72; 95% CI 1.66-1.78; CKD stage 5: HR 2.55; 95% CI 2.37-2.73; CKD stage 5d: 5.64; 95% CI 5.42-5.86; CLTI: 2.06; 95% CI 1.98-2.13; all p < 0.001]. CONCLUSIONS: CKD is a frequent co-morbidity in patients with STEMI and is associated with a worse prognosis especially in advanced stages. Guideline-recommended therapies in patients with STEMI and CKD are still underused.
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Engelbertz et al. (2023) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=175,187). Dialysis-dependent chronic kidney disease (CKD stage 5d) vs. No chronic kidney disease was evaluated on Overall survival (HR 5.64, 95% CI 5.42-5.86, p=<0.001). Dialysis-dependent chronic kidney disease (stage 5d) was associated with significantly decreased overall survival (HR 5.64) compared to normal renal function in patients with ST-elevation myocardial infarction.
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