Patients with end-stage renal disease and acute myocardial infarction have poor short-term outcomes despite modern cardiac intensive care

Abstract

Cardiovascular disease has a tremendous impact on patients with end-stage renal disease (ESRD). We sought to describe the outcomes of patients with ESRD and acute myocardial infarction (AMI). We analyzed consecutive AMI patients admitted to a single coronary care unit, according to the presence or absence of ESRD. Multivariate modeling was used to determine the independent relationship between ESRD and in-hospital mortality. Data were available for 2025 AMI patients. ESRD was present in 82 patients (4%). Coronary angiography and revascularization were used aggressively in patients with ESRD, although less than among patients without ESRD (78 vs. 91%, P<0.001; and 60 vs. 79%, P<0.001, respectively). Length of stay was longer among patients with ESRD (9.5 vs. 5.0 days, P<0.001). In-hospital death occurred in 23.2% of the patients with ESRD compared with 9.0% of patients without ESRD (P<0.001). On multivariate analysis, the presence of ESRD was independently associated with the risk of in-hospital death (odds ratio 2.6, 95% confidence intervals, 1.3-4.9, P=0.005), even after controlling for the use of revascularization. Patients with ESRD and AMI are at tremendous risk for short-term mortality despite the aggressive use of coronary revascularization and modern coronary intensive care.