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Patients with end-stage renal disease requiring hemodialysis benefit from percutaneous coronary intervention after non-ST-segment elevation myocardial infarction

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Abstract

Percutaneous coronary intervention (PCI) treatment significantly improves outcomes after acute myocardial infarction (AMI). It remains unclear whether the benefits of PCI exist in patients with end-stage renal disease (ESRD) and non-ST-segment elevation myocardial infarction (NSTEMI). The present study was designed to investigate the effects of PCI on the short- and long-term prognosis of patients with ESRD and NSTEMI. We conducted a retrospective study from 1 January 2015 to 1 January 2020, which includes 148 consecutive patients with ESRD and NSTEMI. All patients were estimated glomerular filtration rate (eGFR) < 15 mL/min/1.73 m2 and had received regular hemodialysis treatment before hospitalization. Logistic regression analyses were used to identify the risk factors for in-hospital mortality. Cox proportional hazard model was used to identify independent predictors of 1-year major adverse cardiac events (MACE). In this study, 62 patients received PCI treatment. Univariable logistic regression analysis showed that PCI treatment was associated with the trend of reduction in the risk of in-hospital mortality (11.3% vs 43%, P = 0.022), but was not independently related to lower in-hospital mortality risk after multivariable logistic regression analysis (P = 0.131). After a 1-year follow-up, Kaplan–Meier survival analysis demonstrated that MACE rate was significantly lower in patients with ESRD and NSTEMI who had received PCI treatment during hospitalization (P < 0.001). After multivariate Cox proportional hazard analysis, no PCI treatment was independently associated with 1-year MACE (hazard ratios 3.217, 95% CI 2.03–8.489, P = 0.003). PCI treatment during hospitalization is associated with reduced 1-year MACE in patients with ESRD and NSTEMI, which suggests that more aggressive therapies may be beneficial for this special higher risk population.

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Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available due to the restrictions by the Beijing Chaoyang Hospital, but are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

    Yuan Fu, Hao Sun, Kun Zuo, Zongsheng Guo, Li Xu, Mulei Chen & Lefeng Wang

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  1. Yuan Fu
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  2. Hao Sun
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  3. Kun Zuo
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  4. Zongsheng Guo
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  5. Li Xu
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  6. Mulei Chen
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  7. Lefeng Wang
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Contributions

Dr. YF and HS participated in the design, conducted data analysis, and drafted the manuscript. Dr. YF and KZ revised the manuscript according to reviewer comments. Dr. ZSG and LX collected and analyzed part of the data. Dr. MLC and LFW aided interpretation of data, commented on this study design, and provided critical review. All authors have read and approved the final manuscript.

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Correspondence to Lefeng Wang.

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This manuscript is the authors’ original work and all authors declare no conflict of interest.

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The study was approved by the institutional review board of Beijing Chaoyang Hospital and performed in accordance with the Ethical Standards laid down in the 1964 Declaration of Helsinki and its later amendments. This article did not contain any studies with animals performed by any of the authors.

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Fu, Y., Sun, H., Zuo, K. et al. Patients with end-stage renal disease requiring hemodialysis benefit from percutaneous coronary intervention after non-ST-segment elevation myocardial infarction. Intern Emerg Med 17, 1087–1095 (2022). https://doi.org/10.1007/s11739-021-02921-7

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