Didier Romain, Yao Hermann, Legendre Mathieu, Halimi Jean Michel, Rebibou Jean Michel, Herbert Julien, Zeller Marianne, Fauchier Laurent, Cottin Yves
Department of Cardiology, University Teaching Hospital Burgundy, 21000 Dijon, France.
Department of Nephrology, University Teaching Hospital Burgundy, 21000 Dijon, France.
J Clin Med. 2020 Oct 19;9(10):3356. doi: 10.3390/jcm9103356.
Renal transplant recipients have a high peri-operative risk for cardiovascular events. The post-transplantation period also carries a risk of myocardial infarction (MI). Coronary artery disease (CAD) is a leading cause of death in these patients. We aimed to assess the risk of MI, the specific morbidity profile of MI after transplantation as well as the long-term prognosis after MI in renal transplantation (RT) patients regarding cardiovascular (CV) death and all-cause death.
From a French national medical information database, all of the patients seen in French hospitals in 2013 with at least 5-years follow-up were retrospectively identified and patients without transplantation but with previous dialysis at baseline were excluded. There were 17,526 patients with RT and 3,288,857 with no RT.
Among these patients, 1020 in the RT group (5.8%), and 93,320 in the non-RT group (2.8%) suffered acute MI during a median follow-up of 5.4 years. After multivariable adjustment, risk of MI was higher in RT patients than in non-RT patients (HR 1.45, IC 95% 1.35-1.55). The mean age was 59.5 years for transplant patients with MI, and 70.6 years for the reference population with MI ( < 0.0001). MI patients with RT (vs. non RT patients) were more likely to have hypertension, diabetes dyslipidemia, and peripheral artery disease (76.0% vs. 48.1%, 38.7% vs. 25.2%, 33.2% vs. 23.2%, and 31.2% vs. 17.3%, respectively, < 0.0001). Incidence of non ST-elevation MI (NSTEMI) was higher in RT patients while incidence of ST-elevation MI (STEMI) was higher in patients without RT. In unadjusted analysis, risk of all-cause death and CV death within the first month after MI were higher in patients without RT (18% vs. 11.1% < 0.0001 and 12.3% vs. 7.8%, < 0.0001, respectively). However, multivariable analysis indicated that risk of all-cause death was higher in patients with RT than in those with no RT (adjusted HR 1.15 IC 95% 1.03-1.28).
MI is not an uncommon complication after RT (incidence of around 5.8% after 5 years). RT is independently associated with a 45% higher risk of MI than in patients without RT, with a predominance of NSTEMI. MI in patients with RT is independently associated with a 15% higher risk of all-cause death than that in patients with MI and no RT.
肾移植受者围手术期发生心血管事件的风险较高。移植后时期也存在心肌梗死（MI）风险。冠状动脉疾病（CAD）是这些患者死亡的主要原因。我们旨在评估肾移植（RT）患者发生MI的风险、移植后MI的具体发病情况以及MI后关于心血管（CV）死亡和全因死亡的长期预后。
从法国国家医学信息数据库中，回顾性识别出2013年在法国医院就诊且至少随访5年的所有患者，并排除基线时未进行移植但曾接受透析的患者。有17526例RT患者和3288857例未进行RT的患者。
在这些患者中，RT组有1020例（5.8%），非RT组有93320例（2.8%）在中位随访5.4年期间发生急性MI。多变量调整后，RT患者发生MI的风险高于非RT患者（HR 1.45，95%CI 1.35 - 1.55）。发生MI的移植患者平均年龄为59.5岁，MI参照人群平均年龄为70.6岁（P < 0.0001）。发生MI的RT患者（与非RT患者相比）更易患高血压、糖尿病、血脂异常和外周动脉疾病（分别为76.0%对48.1%、38.7%对25.2%、33.2%对23.2%、31.2%对17.3%，P均 < 0.0001）。非ST段抬高型MI（NSTEMI）在RT患者中的发生率较高，而ST段抬高型MI（STEMI）在未进行RT的患者中发生率较高。在未调整分析中，MI后第一个月内非RT患者的全因死亡和CV死亡风险较高（分别为18%对11.1%，P < 0.0001；12.3%对7.8%，P < 0.0001）。然而，多变量分析表明，RT患者的全因死亡风险高于未进行RT的患者（调整后HR 1.15，95%CI 1.03 - 1.28）。
MI是RT后并不罕见的并发症（5年后发生率约为5.8%）。与未进行RT的患者相比，RT独立增加45%的MI发生风险，且以NSTEMI为主。RT患者发生MI后全因死亡风险比未进行RT的MI患者独立高15%。
