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Chronic kidney disease (CKD) has been linked to adverse outcomes in patients with acute myocardial infarction (AMI). It is unclear if CKD on dialysis (D) and CKD not on dialysis (ND) have different prognostic implications. We sought to examine the impact of D and ND on mortality in patients presenting with AMI.
The Nationwide Inpatient Sample (NIS) is the largest public database with characteristics and outcomes of patients discharged from US hospitals. Using the NIS, we identified 374061 adult patients presenting with AMI, both ST elevation and non-ST elevation AMI (NSTEMI) between 2008 and 2010 and they constitute our study population. Among those, 63,476 patients had CKD, 51,462 off and 12,034 on dialysis.
The ND, D and no CKD groups were different in terms of clinical characteristics, presentation, management, and outcome (Table 1). The inhospital mortality for D patients was higher than ND, which was higher, then no CKD patients (11.2% vs. 8.0% vs. 5.0%, respectively. p<0.001). After adjusting for pertinent variables using logistic regression analysis, D remained an independent predictor of higher mortality (p<0.001, OR 1.833 [1.711–1.963]) while ND became an independent predictor of lower mortality (p<0.001, OR 0.843[0.806–0.880]).
Even though CKD in general predicts higher mortality in patients presenting with ami, after adjusting for relevant covariates, D predicted higher while ND predicted lower in-hospital mortality in AMI patients.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Comorbidity and ACS: COPD, Renal Dysfunction, Diabetes
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1257-188
- 2013 American College of Cardiology Foundation