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In-hospital mortality rates more favorable in renal transplant recipients with STEMI vs. stage 5 CKD
Among patients with STEMI, those with renal transplants had better outcomes than those with stage 5D chronic kidney disease, according to new data published in JAMA Cardiology.
In-hospital mortality rates for patients with STEMI and a renal transplant were more similar to the general population with STEMI than to those with STEMI and advanced chronic kidney disease (CKD), the researchers wrote.
“Approximately 45% of deaths in patients with stage 5D CKD have cardiac causes with approximately 15% of these deaths attributable to acute MI,” Tanush Gupta, MD, from the division of cardiology and department of medicine at Westchester Medical Center and New York Medical College in Valhalla, New York, and colleagues wrote. “Although renal transplantation has been shown to be associated with a reduced risk for CVD in patients with stage 5D CKD, CVD is still a major cause of morbidity and the leading cause of death in renal transplant recipients.”
Using data collected from the National (Nationwide) Inpatient Sample from 2003 to 2013, the researchers identified more than 2.3 million patients aged 18 years or older who were hospitalized for STEMI.
Patients were stratified into non-CKD, stage 5D CKD or prior renal transplant groups. The primary outcome was all-cause, in-hospital mortality.
A total of 2,319,002 patients in the non-CKD group (34.7% women; mean age, 64 years), 30,072 patients in the stage 5D CKD group (45% women; mean age, 67 years), and 2,980 patients in the renal transplant group (27.3% women; mean age, 58 years) were identified during the study period.
Reperfusion and mortality
Gupta and colleagues found that 68.9% of the patients in the non-CKD cohort, 39.5% in the stage 5D CKD group and 65.2% in the renal transplant group received in-hospital reperfusion for STEMI.
Compared with the stage 5D CKD group, the renal transplant group was more likely to receive reperfusion (adjusted OR = 1.83; 95% CI, 1.67-2.01), but compared with the non-CKD group, the renal transplant group was less likely to receive reperfusion (adjusted OR = 0.75; 95% CI, 0.68-0.83).
The renal transplant group had much lower risk-adjusted in-hospital mortality than the stage 5D CKD group (adjusted OR = 0.37; 95% CI, 0.33-0.43) but was similar compared with the non-CKD group (adjusted OR = 1.14; 95% CI, 0.99-1.31), according to the researchers.
Reperfusion use increased from 53.7% in the 2003-2004 interval to 81.4% in the 2011-2013 interval (adjusted OR = 1.33; 95% CI, 1.25-1.43) among renal transplant recipients with STEMI, but risk-adjusted in-hospital mortality remained unchanged during the study period, from 8.9% in the 2003-2004 interval to 6.1% in the 2011-2013 interval (adjusted OR = 0.94; 95% CI, 0.85-1.05).
Timely reperfusion needed
“Although it is encouraging that the NIS database demonstrated increased PCI over the period of analysis, the lack of acute reperfusion therapy remains a significant clinical concern,” Robert C. Welsh, MD, FRCPC, FESC, from Mazankowski Alberta Heart Institute in Edmonton, Alberta, Canada, wrote in a related commentary. “This represents a call to action for the practicing clinicians to expedite STEMI diagnosis in these high-risk patient populations and delivering appropriate, timely reperfusion.” – by Dave Quaile
Disclosure: The researchers report no relevant financial disclosures. Welsh reports receiving grants and/or personal fees from AstraZeneca, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, Edwards Lifesciences and Johnson & Johnson.