title: Recent Trends in Management and Inhospital Outcomes of Acute Myocardial Infarction in Renal Transplant Recipients.
abstract: Renal transplant recipients (RTR) are at high risk of cardiovascular events including acute myocardial infarction (AMI). We evaluated recent trends in AMI admissions in 9,243 RTR with functioning grafts using data from the 2003 to 2011 Nationwide Inpatient Sample database. Findings were compared with those of patients with end-stage renal disease without transplantation (ESRD-NRT, n = 160,932) and those without advanced kidney disease (non-ESRD/RT, n = 5,640,851) admitted with AMI. RTR comprised 0.2% of AMI admissions with increasing numbers during the study period (adjusted odds ratio [aOR] 1.04; 95% confidence interval [CI] 1.04 to 1.05; ptrend<0.001). Overall, 29.3% of admissions in RTR were for acute ST-segment elevation myocardial infarction (STEMI). Compared with non-ESRD/RT, history of renal transplantation was independently associated with a decreased likelihood of STEMI at presentation (aOR 0.73; 95% CI 0.65 to 0.80; p <0.001). Inhospital mortality among RTR admitted for NSTEMI decreased from 3.8% in 2003 to 2.1% in 2011 (aOR 0.85; 95% CI 0.78 to 0.93; p <0.001), whereas that for STEMI remained unchanged (7.6% in 2003; 9.3% in 2011, aOR 0.97; 95% CI 0.90 to 1.03; p = 0.36). Rates of percutaneous coronary interventions were higher, and inhospital mortality was lower among RTR compared with ESRD-NRT (p <0.001 for both). Treatment strategies appeared largely unchanged during the course of this study with the exception of an increase in primary percutaneous coronary intervention among RTR admitted with STEMI. In conclusion, RTR were frequently admitted with AMI, particularly NSTEMI, and were found to have multiple coronary artery disease risk factors despite their younger age. Compared with other forms of renal replacement therapy, renal transplant was associated with lower inhospital mortality.
authors.affiliation: Department of Cardiology, St. Luke's University Health Network, Bethlehem, Pennsylvania.
authors.forename: Sahil
authors.initials: S
authors.lastname: Agrawal
authors.affiliation: Department of Cardiology, St. Luke's University Health Network, Bethlehem, Pennsylvania.
authors.forename: Lohit
authors.initials: L
authors.lastname: Garg
authors.affiliation: Department of Cardiology, St. Luke's University Health Network, Bethlehem, Pennsylvania.
authors.forename: Aakash
authors.initials: A
authors.lastname: Garg
authors.affiliation: Department of Cardiology, St. Luke's University Health Network, Bethlehem, Pennsylvania.
authors.forename: Divyanshu
authors.initials: D
authors.lastname: Mohananey
authors.affiliation: Department of Cardiology, St. Luke's University Health Network, Bethlehem, Pennsylvania.
authors.forename: Ankur
authors.initials: A
authors.lastname: Jain
authors.affiliation: Department of Cardiology, St. Luke's University Health Network, Bethlehem, Pennsylvania.
authors.forename: Yugandhar
authors.initials: Y
authors.lastname: Manda
authors.affiliation: Department of Cardiology, St. Luke's University Health Network, Bethlehem, Pennsylvania.
authors.forename: Amitoj
authors.initials: A
authors.lastname: Singh
authors.affiliation: Department of Cardiology, St. Luke's University Health Network, Bethlehem, Pennsylvania.
authors.forename: Sudip
authors.initials: S
authors.lastname: Nanda
authors.affiliation: Department of Cardiology, St. Luke's University Health Network, Bethlehem, Pennsylvania.
authors.forename: Raymond
authors.initials: R
authors.lastname: Durkin
authors.affiliation: Department of Cardiology, St. Luke's University Health Network, Bethlehem, Pennsylvania.
authors.forename: Peter
authors.initials: P
authors.lastname: Puleo
authors.affiliation: Department of Cardiology, St. Luke's University Health Network, Bethlehem, Pennsylvania. Electronic address: jamshid.shirani@sluhn.org.
authors.forename: Jamshid
authors.initials: J
authors.lastname: Shirani
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology; D000368:Aged; D016208:Databases, Factual; D019468:Disease Management; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000601:surgery*; D000072658:Non-ST Elevated Myocardial Infarction / Q000453:epidemiology / Q000601:surgery; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D000072657:ST Elevation Myocardial Infarction / Q000453:epidemiology / Q000601:surgery