The impact of end-stage kidney disease on mortality in patients after acute myocardial infarction: A nationwide study

• Published in: Journal of the Chinese Medical Association Vol. 86; no. 8; pp. 740 - 747
• Main Authors: Chiang, Cheng-Hung, Hung, Wan-Ting, Tai, Ta-Hsin, Cheng, Chin-Chang, Lin, Kun-Chang, Kuo, Shu-Hung, Lin, Su-Chiang, Tang, Pei-Ling, Gao, Chong-En, Weng, Pei-Yu, Ko, Yu-Ling, Fu, Yun-Ju, Kuo, Feng-Yu, Huang, Wei-Chun
• Format: Journal Article
• Language: English
• Published: Netherlands 01.08.2023
• ISSN: 1726-4901; 1728-7731
• DOI: 10.1097/JCMA.0000000000000953

This study aimed to evaluate the impact of end-stage kidney disease (ESKD) on mortality in patients with first-time acute myocardial infarction (AMI). This was a retrospective nationwide cohort study. Patients diagnosed with first-time AMI between January 1, 2000, and December 31, 2012, were included. All patients were followed-up until death or December 31, 2012, whichever occurred first. A one-to-one propensity score matching technique was used to match patients with ESKD to those without ESKD of similar sex, age, comorbidities, and coronary intervention (including percutaneous coronary intervention [PCI] and coronary artery bypass grafting [CABG]). Kaplan-Meier cumulative survival curves were constructed to compare AMI patients with and without ESKD. A total of 186 112 patients were enrolled and 8056 patients with ESKD were identified. Propensity score matched 8056 patients without ESKD were included in the comparison. Overall, the 12-year mortality rate was significantly higher in patients with ESKD than in those without ESKD (log-rank p < 0.0001), including the sex, age, and PCI and CABG subgroups. In Cox proportional-hazard regression analysis, ESKD was an independent risk factor for mortality after patients suffered from first-time AMI (hazard ratio, 1.77; 95% CI, 1.70-1.84; p < 0.0001). A forest plot for subgroup analysis revealed that in AMI patients, ESKD had a higher impact on mortality in male; younger age; without comorbidities such as hypertension, diabetes mellitus, peripheral vascular disease, heart failure, cerebrovascular accident, and chronic obstructive pulmonary disease; and receiving PCI and CABG subgroups. ESKD significantly increases the mortality risk in patients with first-time AMI, including both sexes, different ages, and whether PCI or CABG was performed. In patients with AMI, ESKD has a high impact on mortality in male, younger age, without comorbidities, and those undergoing PCI and CABG.