ST elevation myocardial infarction and kidney transplant: A large cohort study: STEMI and renal transplant. Issue 2 (February 2022)

• Record Type: Journal Article
• Authors: Mir, Tanveer; Uddin, Mohammed; Shah, Asif; Khan, Mohammad Zia; Sheikh, Mujeeb; Rab, Tanveer
• Is Part Of: Journal of cardiology. Volume 79:Issue 2(2022)
• Page Start: 270
• Page End: 276
• Publication Date: 2022-02
• Subjects: ST-elevation myocardial infarction -- Kidney transplant recipients -- Mechanical complications -- Percutaneous coronary intervention -- Coronary procedures; Cardiology -- Periodicals; 616.12
• DOI: 10.1016/j.jjcc.2021.09.006
• Languages: English
• ISSNs: 0914-5087

Abstract

Highlights: ST-elevation myocardial infarction (STEMI) among kidney transplant recipients is associated with high mortality rates. Higher rates of post myocardial infarction mechanical complication rates were observed among kidney transplant recipients. Percutaneous coronary intervention (PCI) was associated with improved mortality rates among kidney transplant recipients who had STEMI. Yearly incidence trend of STEMI among kidney transplant recipients decreased over the years 2012-2018. In-hospital mortality rates of kidney transplant patients increased over the years 2012-2018 while mortality among STEMI patients was steady. Yearly PCI rates trend improved over the study years 2012-2018. Abstract: Background: The literature on outcomes of ST-elevation myocardial infarction (STEMI) amongst kidney transplant recipients (KTR) is limited. Objective: To study the outcomes of STEMI among KTR. Methods: Data from the national readmissions database (NRD) sample that constitutes 49.1% of the stratified sample of all hospitals in the USA were analyzed for hospitalizations with STEMI among KTR for the years 2012-2018. Complications associated with STEMI were extracted using International Classification of Diseases codes. Results: A total of 588, 668 index KTR hospitalizations (mean age 57.67±14.22 years; female 44.5%) of which 3, 496 (0.59%) had STEMI were recorded in the NRD for the years 2012-2018. A total of 11, 676 (1.98%) patients died during the hospitalization. In-hospital mortality among STEMI was higher, 465 (13.3%), than without-STEMI 11, 211 (1.92%). Among the complications, mechanical complications occurred among 1.0% vs 0.02%, cardiogenic shock 10.6 vs 0.3%, ventricular arrythmias 8.3% vs 0.8%, conduction block 6.9% vs 2%, stroke 4.1% vs 1.9%, and acute kidney injury 31.6% vs 28.3% among STEMI and without-STEMI respectively. Among coronary procedures, coronary angiography was performed among 1, 999 (57.2%) of which 1, 777 (50.8%) had percutaneous coronary intervention (PCI). On coarsened exact matching of baseline characteristics, PCI was less likely associated with mortality, odds ratio 0.39 (95% confidence interval 0.24-0.64; p=0.0002). The trends of mortality among STEMI were steady (p-trend 0.11). PCI trend increased (p-trend 0.008) and incidence of STEMI decreased over the study years 2012 (0.66%)-2018(0.474%). A total of 84, 810 (14.4%) patients were readmitted in 30 days of which 696 (20%) patients were among the STEMI subgroup. Conclusion: STEMI is not an uncommon complication among KTR and is associated with significant mechanical complications. Improvement in cardiovascular risk factors might improve the STEMI rates among KTR.