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

• 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
• ISSN: 1573-2584; 0301-1623; 1573-2584
• DOI: 10.1007/s11255-022-03115-6

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.