STEMI in Renal Transplant Recipients

Study Questions:

What are the in-hospital reperfusion rates and outcomes of ST-segment elevation myocardial infarction (STEMI) in renal transplant recipients versus the stage 5D chronic kidney disease (CKD) group or the non-CKD group?

Methods:

The National Inpatient Sample database was queried to identify patients 18 years or older who were hospitalized with the principal diagnosis of STEMI. All hospitalizations for STEMI in the United States from January 1, 2003, to December 31, 2013, were included. Codes from International Classification of Diseases, Ninth Revision, Clinical Modification, were used to identify patients in the non-CKD, stage 5D CKD, or prior renal transplant groups. Data were analyzed from March to May 2016. The main outcome measure was in-hospital mortality.

Results:

From 2003 to 2013, 2,319,002 patients in the non-CKD group (34.7% women; 65.3% men; mean [SD] age, 64.2 [14.4] years), 30,072 patients in the stage 5D CKD group (45.0% women; 55.0% men; mean [SD] age, 66.9 [12.5] years), and 2,980 patients in the renal transplant group (27.3% women; 72.7% men; mean [SD] age, 57.5 [11.1] years) were identified who were hospitalized with STEMI. Of these, 68.9% of the patients in the non-CKD group, 39.5% in the stage 5D CKD group, and 65.2% in the renal transplant group received in-hospital reperfusion for STEMI. The renal transplant group was more likely to receive reperfusion compared with the stage 5D CKD group (adjusted odds ratio [AOR], 1.83; 95% confidence interval [CI], 1.67-2.01; p < 0.001), but less likely compared with the non-CKD group (AOR, 0.75; 95% CI, 0.68-0.83; p < 0.001). Risk-adjusted in-hospital mortality among the renal transplant group with STEMI was markedly lower compared with the stage 5D CKD group (AOR, 0.37; 95% CI, 0.33-0.43; p < 0.001), but similar compared with the non-CKD group (AOR, 1.14; 95% CI, 0.99-1.31; p = 0.08). Among renal transplant recipients with STEMI, the use of reperfusion increased from 53.7% in the 2003-2004 interval to 81.4% in the 2011-2013 interval (AOR, 1.33; 95% CI, 1.25-1.43; p < 0.001 for trend), whereas risk-adjusted in-hospital mortality remained unchanged during the study period, from 8.9% in the 2003-2004 interval to 6.1% in the 2011-2013 interval (AOR, 0.94; 95% CI, 0.85-1.05; p = 0.27 for trend).

Conclusions:

The authors concluded that in-hospital mortality rates in renal transplant recipients with STEMI are more favorable compared with those of patients with stage 5D CKD.

Perspective:

This retrospective study reports that post-renal transplant patients had modestly lower in-hospital reperfusion rates for STEMI compared with patients without CKD, but had similar risk-adjusted in-hospital mortality and mean length of stay (LOS). Compared with the stage 5D CKD group, the renal transplant group was much more likely to receive reperfusion and had markedly lower risk-adjusted in-hospital mortality and shorter mean LOS. Additional prospective studies are indicated to confirm these findings and explore the mechanisms that may contribute to improved STEMI outcomes in renal transplant recipients versus those on dialysis. In addition, practicing clinicians should expedite STEMI diagnosis in patients with CKD and deliver appropriate timely reperfusion, given the low rates of reperfusion currently seen in this population.


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