Abstract 11138: Survival of US Dialysis Patients after Acute Myocardial Infarction: Is it Finally Getting Better in the Modern Treatment Era?
Introduction: Acute myocardial infarction (AMI) is a catastrophic event associated with dismal long-term survival in dialysis pts. We previously reported mortality rates at 1 and 2 yrs respectively for AMI of 55% and 71% in 1977-84, 62% and 74% in 1990-95. We sought to analyze survival trends in dialysis pts by type of AMI (STEMI/NSTEMI) in the contemporary era.
Methods: Using the United States Renal Data System (USRDS) database, we identified prevalent ESRD pts hospitalized for an index AMI in 1993, 1998, 2003 and 2008. AMI type was determined from ICD-9-CM codes. Unadjusted mortality was estimated by Kaplan-Meier method with subsequent adjustment for age, gender, race, dialysis vintage (time on dialysis), and etiology of ESRD.
Results: A total of43,168 dialysis AMI pts were identified. From 1993 to 2008 there was a proportional increase in age 75+ (23% vs 31%), blacks (25% vs 31%), diabetic ESRD (42% vs 55%), and 5yr+ dialysis vintage (15% vs 26%) but not gender (53% vs 54% male). In 1993, 1998, 2003 and 2008 respectively, # of pts with NSTEMI was 1898, 4502, 9701, 13210; STEMI 1658, 2245, 2331, 1571; unspecified AMI 938, 1334, 2200, 1580 pts. Unadjusted mortality rates (by yrs 1993 to 2008) for all AMI pts at 1 yr were 63.3%, 61.8%, 61.1%, and 56.6% and at 2 yrs were 76.5%, 75.6%, 74.8%, and 71.5% respectively. In-hospital death(STEMI) of 38.2% in 1993 dropped to 25.9% in 2008, but no change in NSTEMI (14.2% and 14.9%). The Table shows adjusted mortality by AMI type. Between 1993 & 2008, the adjusted 1 yr mortality markedly decreased for STEMI pts (69% vs 56%) but not NSTEMI pts (53% vs 52%).
Conclusion: From 1993 to 2008 the number of dialysis pts with AMI nearly quadrupled, due solely to increased NSTEMI, likely reflecting diagnosis of NSTEMI by more sensitive cardiac biomarkers. AMI mortality in dialysis pts has declined over 15 yrs, but only in STEMI pts. Survival of NSTEMI dialysis pts has not materially improved in the modern treatment era.
- © 2012 by American Heart Association, Inc.