Abstract 10621: Trends of Early Coronary Revascularization With Acute Myocardial Infarction among Patients on Long-term Dialysis over 15 Years in the United States
Introduction: Acute myocardial infarction (AMI) is a catastrophic event associated with dismal long-term survival in dialysis pts. We have previously reported that 1yr mortality rates of STEMI but not NSTEMI pts have significantly reduced in the past 15 yrs. We evaluated the rates of early coronary revascularization in AMI pts to determine if increasing revascularization rates were associated with improved survival.
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. We identified patients undergoing coronary revascularization with thrombolytics, percutaneous intervention (PCI) or coronary bypass graft surgery (CABG) using ICD-9 procedure codes or CPT codes. We further evaluated whether revascularization occurred in the first day, first two hospital days, or during entire hospitalization.
Results: Between 1993 & 2008, there was an increase in NSTEMI (1898 vs 13201) but not STEMI (1658 vs 1571) pts. Rates of in-hospital PCI increased steadily (Figure) but were more marked among STEMI (8% vs 38%, p<0.001) vs NSTEMI pts (5% vs 16%, p<0.001). Among pts receiving in-hospital PCI in 2008 for AMI, 71% STEMI and 18% NSTEMI pts had procedures within 24 hrs of admission. Rates of in-hospital CABG and thrombolytics were low, and did not change substantially in 15 yrs. We have previously reported that 1 yr mortality for dialysis STEMI pts markedly decreased between 1993 & 2008 (69% vs 56%) but remained constant for NSTEMI pts (53% vs 52%) in this study cohort.
Conclusion: There has been a significant increase in early coronary revascularization rates among dialysis AMI pts over 15 yrs, more marked in STEMI compared to NSTEMI pts. These increased revascularization rates are associated with improved 1 yr survival among dialysis STEMI but not NSTEMI pts. These trends probably reflect diffusion of evidence based guidelines to this high risk population.
- © 2013 by American Heart Association, Inc.