Prognostic impact of percutaneous coronary intervention in chronic dialysis patients with acute myocardial infarction

Abstract

Abstract Background Patients on chronic dialysis are less likely to receive percutaneous coronary intervention (PCI) for treatment of acute myocardial infarction (AMI). This is due to the lack of evidence from randomized trials, concerns about possible PCI-related side effects, and multimorbidity. Thus, routine use of PCI for treatment of dialysis patients with AMI remains an unresolved issue. Purpose We analyzed data of patients on chronic dialysis hospitalized with AMI (both ST-elevation myocardial infarction [STEMI] and non-ST-elevation myocardial infarction [NSTEMI]) from 2003 to 2018, by using the administrative Lombardy Health Database (Italy). Patients were grouped according to whether they were treated or not with PCI during hospitalization. The primary outcome was in-hospital mortality while 1-year mortality was the secondary endpoint. Results During the study period, 265,048 patients were hospitalized with AMI in Lombardy. Of them, 3,206 (1.2%) were on chronic dialysis (age 71±11; 72% males). Among dialysis patients, 44% were treated with PCI, while 54% underwent PCI among non-dialysis patients (P<0.0001). Dialysis was an independent predictor of conservative treatment with medical therapy only (OR 0.75 [95% CI 0.70-0.81]). In-hospital mortality in the dialysis cohort was 15%. It was significantly lower in patients treated with PCI than in those not treated with PCI (11% vs. 19%; P<0.0001). One-year mortality was 47% and it was lower in PCI-treated patients (33% vs. 52%; P<0.0001). The adjusted risk of the study endpoints was significantly lower in dialysis patients treated with PCI: OR 0.62 (95% CI 0.50-0.76) for in-hospital mortality; HR 0.63 (95% CI 0.56-0.71) for 1-year mortality. Similar results were found in STEMI and NSTEMI patients considered separately. Conclusions Our real-world data showed that in patients with AMI on chronic dialysis, PCI use is associated with a significant in-hospital and 1-year survival benefit.