title: Patients with end-stage renal disease and acute myocardial infarction have poor short-term outcomes despite modern cardiac intensive care.
abstract: OBJECTIVE
  Cardiovascular disease has a tremendous impact on patients with end-stage renal disease (ESRD). We sought to describe the outcomes of patients with ESRD and acute myocardial infarction (AMI).
  
  
  METHODS
  We analyzed consecutive AMI patients admitted to a single coronary care unit, according to the presence or absence of ESRD. Multivariate modeling was used to determine the independent relationship between ESRD and in-hospital mortality.
  
  
  RESULTS
  Data were available for 2025 AMI patients. ESRD was present in 82 patients (4%). Coronary angiography and revascularization were used aggressively in patients with ESRD, although less than among patients without ESRD (78 vs. 91%, P<0.001; and 60 vs. 79%, P<0.001, respectively). Length of stay was longer among patients with ESRD (9.5 vs. 5.0 days, P<0.001). In-hospital death occurred in 23.2% of the patients with ESRD compared with 9.0% of patients without ESRD (P<0.001). On multivariate analysis, the presence of ESRD was independently associated with the risk of in-hospital death (odds ratio 2.6, 95% confidence intervals, 1.3-4.9, P=0.005), even after controlling for the use of revascularization.
  
  
  CONCLUSIONS
  Patients with ESRD and AMI are at tremendous risk for short-term mortality despite the aggressive use of coronary revascularization and modern coronary intensive care.
authors.affiliation: Washington Hospital Center, Washington DC 20010, USA. howard.a.cooper@medstar.net
authors.forename: Howard A
authors.initials: HA
authors.lastname: Cooper
authors.forename: Cecilia
authors.initials: C
authors.lastname: Monge
authors.forename: Julio A
authors.initials: JA
authors.lastname: Panza
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D001026:Coronary Artery Bypass; D003325:Coronary Care Units; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000601:surgery