Syncope and Collapse Are Associated with an Increased Risk of Cardiovascular Disease and Mortality in Patients Undergoing Dialysis.

Shih-Ting Huang,Shih-Ting Huang,Tai-Yuan Ke,Ming-Ju Wu,Cheng-Li Lin,Cheng-Li Lin,Wen-Miin Liang,Chia-Hung Kao,Chia-Hung Kao,Chi-Yuan Li,Tzu-Chieh Chou,Ya-Wen Chuang,Tung-Min Yu,Chih-Wei Chiu

doi:10.3390/ijerph15102082

Abstract

Objective: This study explored the impact of syncope and collapse (SC) on cardiovascular events and mortality in patients undergoing dialysis. Methods: Patients undergoing dialysis with SC (n = 3876) were selected as the study cohort and those without SC who were propensity score-matched at a 1:1 ratio were included as controls. Major adverse cardiovascular events (MACEs), including acute coronary syndrome (ACS), arrhythmia or cardiac arrest, stroke, and overall mortality, were evaluated and compared in both cohorts. Results: The mean follow-up periods until the occurrence of ACS, arrhythmia or cardiac arrest, stroke, and overall mortality in the SC cohort were 3.51 ± 2.90, 3.43 ± 2.93, 3.74 ± 2.97, and 3.76 ± 2.98 years, respectively. Compared with the patients without SC, those with SC had higher incidence rates of ACS (30.1 vs. 24.7 events/1000 people/year), arrhythmia or cardiac arrest (6.75 vs. 3.51 events/1000 people/year), and stroke (51.6 vs. 35.7 events/1000 people/year), with higher overall mortality (127.7 vs. 77.9 deaths/1000 people/year). The SC cohort also had higher risks for ACS, arrhythmia or cardiac arrest, stroke, and overall mortality (adjusted hazard ratios: 1.28 (95% confidence interval (CI) = 1.11–1.46), 2.05 (95% CI = 1.50–2.82), 1.48 (95% CI = 1.33–1.66), and 1.79 (95% CI = 1.67–1.92), respectively) than did the non-SC cohort. Conclusion: SC was significantly associated with cardiovascular events and overall mortality in the patients on dialysis. SC may serve as a prodrome for cardiovascular comorbidities, thereby assisting clinicians in identifying high-risk patients.

Highlights

Patients undergoing dialysis have an extremely high prevalence of death (198 deaths/1000 patients/year) [1]
The incidence and prevalence rates of syncope and collapse (SC) among the patients undergoing dialysis increased during the follow-up period (Supplemental Figure S1)
Crude hazard ratios (HRs): relative hazard ratio; ACS: acute coronary syndrome; 95% confidence intervals (CIs): 95% confidence interval; † Only confounding variables that were found to be significant in the univariable model were further analyzed; * p < 0.05, ** p < 0.01, *** p < 0.001

Summary

Introduction

Patients undergoing dialysis have an extremely high prevalence of death (198 deaths/1000 patients/year) [1]. Among such patients, cardiovascular disease (CVD) is the major cause of death, accounting for approximately 40% of all-cause mortality [2]. In the United States Renal Data System database, the leading specific cause of cardiac death is arrhythmia or sudden cardiac arrest (SCA), accounting for the deaths of approximately 60% of patients, followed by coronary heart disease (CHD), accounting for the deaths of approximately 20% of patients in the dialysis population [3]. The current trend of declining mortality rates among patients with ESRD [6] can be explained by the secondary prevention of CVD [7], little evidence of benefits generated by risk factor modification has been found among a dialysis population. The most likely explanation for ineffective treatment is that most cardiac deaths are attributed to SCA or arrhythmias, and the responsible mechanisms are still unclear

Methods

Results

Conclusion