Abstract 15785: Prognostic Value of Silent Myocardial Infarction in End-stage Renal Disease
Introduction: Patients with end-stage renal disease (ESRD) have an increased risk of cardiac events including myocardial infarction (MI). Silent MIs (SMIs) have been shown to be more common in patients with chronic kidney disease and associated with increased mortality risk. The prevalence and prognostic value of SMI in ESRD has not been evaluated.
Methods: We identified consecutive patients with ESRD who were evaluated for renal transplantation at the University of Alabama at Birmingham between June of 2004 and January of 2006. Clinical MI (CMI) was determined by review of medical records. SMI was defined as ECG evidence of MI without prior clinical history of MI. The primary end-point was a composite of death, MI, or coronary revascularization censored at time of renal transplantation.
Results: Our cohort included 1007 patients aged 48±12 years (58% men, 43% Caucasian, 43% diabetes, 75% dialysis). The prevalence of SMI and CMI was 10.7% and 6.7%, respectively. During a median follow-up of 28 months (inter-quartile range 6-59), 376 (37%) patients experienced the primary outcome (33% death, 2% MI, 5% coronary revascularization). Compared to patients without evidence of MI (6%, 18%, 27%), patients with SMI (12%, 38%, 53%) and CMI (14%, 41%, 55%) had increased risk of events during follow-up (Figure; 1, 3, and 5 year event rates shown, log-rank p<0.001). In a Cox-proportional model for the composite outcome that adjusted for age, gender, race, diabetes, hypertension, hyperlipidemia and dialysis, both SMI (unadjusted HR 1.58, p=0.003, adjusted HR 1.39, p=0.045) and CMI (unadjusted HR 2.03. p<0.001, adjusted HR 1.66, p=0.005) were independently associated with outcomes. In patients without CMI, the only independent predictor of SMI was older age (odds ratio for age ≥50 yrs 2.32, p<0.001).
Conclusions: SMIs are common in patients with ESRD and are more frequent than CMIs. Both SMI and CMI are associated with increased risk of future cardiovascular events.
Author Disclosures: A. Farag: None. J. Neill: None. H. Doppalapudi: None. V. Kumar: None. D. Rizk: None. A. Iskandrian: None. F.G. Hage: None.
- © 2016 by American Heart Association, Inc.