Abstract 10974: Impact of Acute Myocardial Infarction on Survival of US Dialysis Patients After Surgical or Percutaneous Coronary Revascularization
Background: Published data in US dialysis pts show that CABG has a higher initial mortality hazard but better long-term survival than PCI. However, the impact of acute myocardial infarction (AMI) has not been factored into these analyses. We sought to evaluate survival in dialysis pts undergoing coronary revascularization in the context of AMI.
Methods: Using the United States Renal Data System database, we identified 23,033 dialysis pts undergoing revascularization, 2004-2009. Pts with AMI were identified by ICD-9 codes [n=8,258 (36%); 1820 CABG; 4210 DES, 2228 BMS]. ST-elevation (STEMI) and non-STEMI (NSTEMI) pts were also identified. Long-term survival was estimated by Kaplan-Meier method and independent predictors of death examined in a comorbidity-adjusted Cox model.
Results: From 2004-2009, 30% CABG, 36% DES and 45% BMS procedures were performed for AMI; a majority of these were for NSTEMI (75% vs 16% STEMI, 9% unknown). There was an initial mortality hazard with CABG, the 1 yr survival with CABG and PCI/DES was similar (graph); subsequent long-term survival was consistently more favorable for pts undergoing CABG. Relative to CABG, PCI with DES was associated with higher mortality risk (HR 1.12; CI 1.05-1.20) in pts with AMI. The mortality hazard was higher for NSTEMI (HR 1.13; 1.04-1.23) but not STEMI (HR 1.11; 0.93-1.31) pts. BMS was also associated with significantly increased hazard of mortality among AMI pts (HR 1.29; 1.20-1.40) relative to CABG. Other independent predictors of mortality among AMI pts undergoing revascularization with AMI were: age> 65 yrs, white race, dialysis vintage > 2 yrs, peritoneal dialysis.
Conclusions: Among US dialysis pts undergoing coronary revascularization with AMI, CABG had better long-term survival compared to PCI with DES in the context of NSTEMI but not STEMI. BMS was associated with higher mortality hazard relative to CABG in NSTEMI and STEMI pts.
- © 2013 by American Heart Association, Inc.