ST-Elevation Myocardial Infarction Admissions in Those With Kidney Transplant - Nationwide Trends and Outcomes.

Abstract

Background: ST-Elevation myocardial infarction (STEMI) incidence is declining in general population attributable to primary prevention. Though cardiovascular disease is common in kidney transplant patients, impact of prevention practices on incidence and outcomes of STEMI in them is unknown. We looked at incidence and outcomes of kidney transplant patients admitted with STEMI. Methods: From Nationwide Inpatient Sample, admissions for primary diagnosis of non-elective STEMI from 2005-2010 were estimated for kidney transplant recipients and general population. Those on maintenance dialysis were excluded. Incidence of STEMI admissions was calculated using data from USRDS and US Census. Age-adjusted incidence rates were compared using linear regression. Differences in acute kidney injury (AKI), mortality and adjusted risk factors for mortality were evaluated. Results: Of estimated 1,060,307(95%CI:998,082-1,122,531) STEMI admissions, 1,325 (0.1%) were kidney transplant recipients. Kidney transplant recipients were younger, more often male, non-white, with public payer and admitted more to teaching hospitals. Incidence of STEMI was higher in kidney transplant recipients(143.6 vs 80.5 per 105 with incidence rate ratio 1.78;95%CI:1.78-1.79). Age-adjusted incidence of STEMI declined in general population. A similar trend was seen in kidney transplant recipients, but was not statistical significant(Fig 1). Prevalence of AKI needing dialysis was higher in kidney transplant group(3.6% vs 0.4%;p<0.001) and that of percutaneous interventions was lower(60.6% vs 67.8%;p=0.01). There was a trend towards increased mortality in kidney transplant admissions(9.9% vs 7.0%; p=0.06). On adjusted analysis, odds of mortality were higher in kidney transplant recipients(OR 2.34; 95% CI: 1.52-3.58). Conclusions: Incidence of STEMI admissions continues to be higher in those with kidney transplant. Those with kidney transplant are more likely to develop AKI and have higher mortality.Figure: No Caption available.