The use of invasive cardiac procedures after acute myocardial infarction in long-term dialysis patients.
BACKGROUND
Dialysis patients have an excessive risk of cardiovascular death after myocardial infarction (MI). Underutilization of cardiac therapies may partially explain this risk, but whether patients on maintenance dialysis have differential rates of coronary angiography or revascularization during admission for MI compared with patients not on dialysis and whether these differences are explained by the presence of comorbid illness were uncertain.


METHODS
We analyzed 154,692 patients with a primary diagnosis of MI in the 2001 National Inpatient Sample, and we compared procedure use in patients on long-term dialysis, patients with non-dialysis-dependent chronic kidney disease (CKD), or normal renal function.


RESULTS
Dialysis patients and patients with dialysis-independent CKD were significantly less likely to undergo coronary angiography than patients with normal renal function (39% and 34% vs 56%). They were also less likely to undergo coronary revascularization (19% and 23% vs 41%) or to have a coronary intervention after diagnostic angiography (46% and 62% vs 70%). After adjustment, these differences remained, with a lower likelihood of angiography (42% and 45% vs 56%), revascularization (22% and 31% vs 41%), or coronary intervention after diagnostic angiography (52% and 66% vs 70%).


CONCLUSIONS
Despite a high mortality rate after MI, patients on dialysis are markedly less likely than patients with dialysis-independent CKD or normal renal function to undergo diagnostic angiography or coronary revascularization after admission for MI. Additional studies to determine how these disparities are related to mortality are warranted.
Charytan
David
D
Division of Clinical Biometrics, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. cdcharytan@partners.org
Mauri
Laura
L
Agarwal
Anupam
A
Servoss
Steven
S
Scirica
Benjamin
B
Kuntz
Richard E
RE
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D017023:Coronary Angiography / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003935:Diagnostic Techniques, Cardiovascular / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D008134:Long-Term Care; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data