Invasive coronary artery disease assessment and myocardial infarction in patients on renal replacement therapy

Background The incidence of myocardial infarction (MI) is elevated in patients receiving renal replacement therapy (RRT). We hypothesized that an invasive strategy of assessment of coronary artery disease (CAD) will identify patients more prone to developing MI. Methods This was a single-center obse...

Full description

Saved in:
Bibliographic Details
Published in:International urology and nephrology 2022-08, Vol.54 (8), p.2083-2092
Main Authors: De Lima, Jose Jayme G., Gowdak, Luis Henrique W., Reusing, Jose Otto, David-Neto, Elias, Bortolotto, Luiz A.
Format: Article
Language:English
Subjects:
Cardiovascular disease
Coronary artery
Coronary vessels
Diabetes mellitus
Heart attacks
Heart diseases
Hemodialysis
Kidney transplantation
Lethality
Medicine
Medicine & Public Health
Multivariate analysis
Myocardial infarction
Nephrology
Nephrology - Original Paper
Renal replacement therapy
Risk factors
Urology
Vein & artery diseases
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background The incidence of myocardial infarction (MI) is elevated in patients receiving renal replacement therapy (RRT). We hypothesized that an invasive strategy of assessment of coronary artery disease (CAD) will identify patients more prone to developing MI. Methods This was a single-center observational cohort study that included 1678 patients receiving RRT (hemodialysis and renal transplantation) assessed for CAD prospectively and analyzed retrospectively. Endpoints were the incidence of MI and death. Results The median follow-up was 43 months, and 180 patients experienced an MI with a mortality rate of 74%. Multivariate analysis showed that diabetes (HR 1.633; 95% CI 1.165–2.289), prior MI (HR 1.724; 95% CI 1.153–2.579), and CAD (HR 2.073; 95% CI 1.400–3.071) were predictors of MI. Altered myocardial scan did not correlate with MI. At the discretion of the attending physicians, 20/180 patients (11%) underwent coronary intervention that was associated with a higher cumulative survival (Log-rank 0.007). Conclusion Patients with CAD suffered an MI more frequently, independently of symptoms and risk factors for MI, including noninvasive testing. Because of the elevated rate of the lethality of MI, invasive coronary studies may be indicated in select patients on RRT. Once an MI occurs, our data suggest that an invasive therapeutic approach is warranted.
ISSN:1573-2584
0301-1623
1573-2584
DOI:10.1007/s11255-022-03115-6