Impact of dialysis dependence on prognosis in patients with myocardial infarction An 11-year population-based study

In this study we aimed to directly compare the short and long-term prognosis of nondialysis patients with chronic kidney disease (CKD), dialysis patients, and patients with preserved renal function after acute myocardial infarction (AMI). AMI in patients with CKD is a catastrophic event associated with high medical expenditures and dismal survival. However, there is little research comparing post-AMI outcomes between patients with CKD who were and were not receiving dialysis. The retrospective cohort study included patients with AMI (n=158,125) in the Taiwan's National Health Insurance Research Database who were treated March 1998 and December 2009. Patients were classified into a nondialysis CKD group (n=6300), dialysis group (n=5140), and a control group (n=146,685). The clinical characteristics, in-hospital events, and long-term outcomes of these 3 groups were compared separately using a multivariable Cox proportional hazard model. The risks of in-hospital death and 2-year all-cause mortality were the highest in the dialysis group, followed by the nondialysis CKD group, and were the lowest in the control group. The 1-year risk of myocardial infarction did not differ among the 3 study groups, but the 2-year risk of myocardial infarction was higher in the dialysis group than in the control group (hazard ratio, 1.13; 95% confidence interval, 1.03-1.24; P=.010). Patients with CKD experienced adverse short-and long-term outcomes after acute myocardial infarction. Patients with CKD, especially those who are dialysis dependent, may require more intensive management to improve their post-AMI clinical outcomes.