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

  • Nephrology - Original Paper
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Abstract

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.

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Authors and Affiliations

  1. Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Rua Eneas Carvalho Aguiar 44, São Paulo, SP, 05403-000, Brazil

    Jose Jayme G. De Lima, Luis Henrique W. Gowdak & Luiz A. Bortolotto

  2. Renal Transplant Unit, Urology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, Brazil

    Jose Otto Reusing & Elias David-Neto

Authors
  1. Jose Jayme G. De Lima
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  2. Luis Henrique W. Gowdak
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  3. Jose Otto Reusing
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  4. Elias David-Neto
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  5. Luiz A. Bortolotto
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Contributions

JJGDL: participated in research design, participated in the writing of the paper, participated in the performance of the research, participated in data analysis. LHWG: participated in research design, participated in the performance of the research, participated in data analysis. JORJ: participated in research design, participated in data analysis. ED-N: participated in data analysis. LAB: participated in research design, participated in data analysis.

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Correspondence to Jose Jayme G. De Lima.

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All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number 3428/10/17) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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De Lima, J.J.G., Gowdak, L.H.W., Reusing, J.O. et al. Invasive coronary artery disease assessment and myocardial infarction in patients on renal replacement therapy. Int Urol Nephrol 54, 2083–2092 (2022). https://doi.org/10.1007/s11255-022-03115-6

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  • DOI: https://doi.org/10.1007/s11255-022-03115-6

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