Takasaki Akihiro, Kurita Tairo, Hirabayashi Yosuke, Matsuo Hiroshi, Tanoue Akiko, Masuda Jun, Yamanaka Takashi, Katayama Kan, Machida Hirofumi, Ichikawa Takehiko, Ito Masaaki, Dohi Kaoru
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan.
Department of Nephrology, Suzuka Kaisei Hospital, Suzuka, Japan.
Heart Vessels. 2022 Feb;37(2):208-218. doi: 10.1007/s00380-021-01919-7. Epub 2021 Aug 4.
Cardiovascular events and death are more prevalent in hemodialysis (HD) patients than in the general population. However, a detailed prognostic risk stratification of HD patients with acute myocardial infarction (AMI) has not yet been performed in the modern interventional era. We examined 4509 AMI patients (89 AMI/HD and 4420 AMI/non-HD) from the Mie ACS registry and detailed prognostic analyses based on the Killip classification were performed (Cohort A). In addition, prognosis of Killip class1 AMI/HD was compared with those of 313 non-AMI/HD patients from the MIE-CARE HD study using propensity score-matching method (Cohort B). Primary endpoint was all-cause mortality for up to 2 years. All-cause death occurred in 13.0% of AMI/non-HD and 35.8% of AMI/HD during follow-up, and patients with Killip class 1 had lower 30-day and 2-year mortality than those with Killip class ≥ 2 in both AMI/non-HD and AMI/HD. Cox regression analyses identified that Killip class ≥ 2 was the strongest independent prognostic factor of 30-day mortality with a hazard ratio of 7.44 (p < 0.001), whereas both presence of HD and Killip class ≥ 2 were the independent prognostic factors of mortality for up to 2 years. In Cohort B, a propensity score-matching analysis revealed similar all-cause mortality rates between Killip class 1 AMI/HD and non-AMI/HD. In HD patients with Killip class 1 AMI, 30-day mortality was around 6%, and long-term mortality among 30-day survivors after AMI was comparable with the natural course of HD patients in the modern interventional era. Clinical trial registration: URL: https://www.umin.ac.jp/ctr/index-j.htm . UMIN000036020 and UMIN000008128.
心血管事件和死亡在血液透析（HD）患者中比在普通人群中更为普遍。然而，在现代介入治疗时代，尚未对急性心肌梗死（AMI）的HD患者进行详细的预后风险分层。我们研究了来自三重县急性冠状动脉综合征（ACS）登记处的4509例AMI患者（89例AMI/HD和4420例AMI/非HD），并基于Killip分级进行了详细的预后分析（队列A）。此外，使用倾向评分匹配法将Killip 1级AMI/HD患者的预后与来自MIE-CARE HD研究的313例非AMI/HD患者的预后进行比较（队列B）。主要终点是长达2年的全因死亡率。随访期间，全因死亡发生在13.0%的AMI/非HD患者和35.8%的AMI/HD患者中，在AMI/非HD和AMI/HD患者中，Killip 1级患者的30天和2年死亡率均低于Killip≥2级患者。Cox回归分析确定，Killip≥2级是30天死亡率最强的独立预后因素，危险比为7.44（p<0.001），而HD的存在和Killip≥2级都是长达2年死亡率的独立预后因素。在队列B中，倾向评分匹配分析显示Killip 1级AMI/HD和非AMI/HD之间的全因死亡率相似。在Killip 1级AMI的HD患者中，30天死亡率约为6%，AMI后30天幸存者的长期死亡率与现代介入治疗时代HD患者的自然病程相当。临床试验注册：网址：https://www.umin.ac.jp/ctr/index-j.htm . UMIN000036020和UMIN000008128。
