Background Cardiovascular disease is common in patients on long-termdialysis, and it accounts for 44 percent of overall mortalityin this group. We undertook a study to assess long-term survivalafter acute myocardial infarction among patients in the UnitedStates who were receiving long-term dialysis.
Methods Patients on dialysis who were hospitalized during theperiod from 1977 to 1995 for a first myocardial infarction afterthe initiation of renal-replacement therapy were retrospectivelyidentified from the U.S. Renal Data System data base. Overallmortality and mortality from cardiac causes (including all in-hospitaldeaths) were estimated by the life-table method. The effectof independent predictors on survival was examined in a Coxregression model with adjustment for existing illnesses.
Results The overall mortality (±SE) after acute myocardialinfarction among 34,189 patients on long-term dialysis was 59.3±0.3percent at one year, 73.0±0.3 percent at two years, and89.9±0.2 percent at five years. The mortality from cardiaccauses was 40.8±0.3 percent at one year, 51.8±0.3percent at two years, and 70.2±0.4 percent at five years.Patients who were older or had diabetes had higher mortalitythan patients without these characteristics. Adverse outcomesoccurred even in patients who had acute myocardial infarctionin 1990 through 1995. Also, the mortality rate after myocardialinfarction was considerably higher for patients on long-termdialysis than for renal-transplant recipients.
Conclusions Patients on dialysis who have acute myocardial infarctionhave high mortality from cardiac causes and poor long-term survival.
Source Information
From the Divisions of Cardiology (C.A.H.) and Nephrology (J.Z.M., A.J.C.), Department of Internal Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis.
Address reprint requests to Dr. Herzog at the Hennepin County Medical Center, 701 Park Ave., Minneapolis, MN 55415.
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McCullough, P. A., Nowak, R. M., Foreback, C., Tokarski, G., Tomlanovich, M. C., Khoury, N., Weaver, W. D., Sandberg, K. R., McCord, J.
(2002). Emergency Evaluation of Chest Pain in Patients With Advanced Kidney Disease. Arch Intern Med
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Herzog, C. A., Ma, J. Z., Collins, A. J.
(2002). Comparative Survival of Dialysis Patients in the United States After Coronary Angioplasty, Coronary Artery Stenting, and Coronary Artery Bypass Surgery and Impact of Diabetes. Circulation
106: 2207-2211
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Chow, K. M., Szeto, C. C., Wong, T. Y.-h., Leung, F. K.-t., Cheuk, A., Li, P. K.-t.
(2002). Diabetic Muscle Infarction: Myocardial infarct equivalent. Diabetes Care
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Shlipak, M. G., Heidenreich, P. A., Noguchi, H., Chertow, G. M., Browner, W. S., McClellan, M. B.
(2002). Association of Renal Insufficiency with Treatment and Outcomes after Myocardial Infarction in Elderly Patients. ANN INTERN MED
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Wright, R. S., Reeder, G. S., Herzog, C. A., Albright, R. C., Williams, B. A., Dvorak, D. L., Miller, W. L., Murphy, J. G., Kopecky, S. L., Jaffe, A. S.
(2002). Acute Myocardial Infarction and Renal Dysfunction: A High-Risk Combination. ANN INTERN MED
137: 563-570
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Townsend, R. R.
(2002). Cardiac Mortality in Chronic Kidney Disease: A Clearer Perspective. ANN INTERN MED
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McCullough, P. A, Sandberg, K. R, Yee, J., Hudson, M. P
(2002). Mortality benefit of angiotensin-converting enzyme inhibitors after cardiac events in patients with end-stage renal disease. Journal of Renin-Angiotensin-Aldosterone System
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Al Suwaidi, J., Reddan, D. N., Williams, K., Pieper, K. S., Harrington, R. A., Califf, R. M., Granger, C. B., Ohman, E. M., Holmes, D. R. Jr, for the GUSTO-IIb, GUSTO-III, PURSUIT, and PARAGON,
(2002). Prognostic Implications of Abnormalities in Renal Function in Patients With Acute Coronary Syndromes. Circulation
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