Internal Medicine, Detroit Medical Center Wayne State University, Detroit, MI, United States.
Internal Medicine, Detroit Medical Center Wayne State University, Detroit, MI, United States.
J Cardiol. 2022 Feb;79(2):270-276. doi: 10.1016/j.jjcc.2021.09.006. Epub 2021 Sep 24.
The literature on outcomes of ST-elevation myocardial infarction (STEMI) amongst kidney transplant recipients (KTR) is limited.
To study the outcomes of STEMI among KTR.
Data from the national readmissions database (NRD) sample that constitutes 49.1% of the stratified sample of all hospitals in the USA were analyzed for hospitalizations with STEMI among KTR for the years 2012-2018. Complications associated with STEMI were extracted using International Classification of Diseases codes.
A total of 588,668 index KTR hospitalizations (mean age 57.67±14.22 years; female 44.5%) of which 3,496 (0.59%) had STEMI were recorded in the NRD for the years 2012-2018. A total of 11,676 (1.98%) patients died during the hospitalization. In-hospital mortality among STEMI was higher, 465 (13.3%), than without-STEMI 11,211 (1.92%). Among the complications, mechanical complications occurred among 1.0% vs 0.02%, cardiogenic shock 10.6 vs 0.3%, ventricular arrythmias 8.3% vs 0.8%, conduction block 6.9% vs 2%, stroke 4.1% vs 1.9%, and acute kidney injury 31.6% vs 28.3% among STEMI and without-STEMI respectively. Among coronary procedures, coronary angiography was performed among 1,999 (57.2%) of which 1,777 (50.8%) had percutaneous coronary intervention (PCI). On coarsened exact matching of baseline characteristics, PCI was less likely associated with mortality, odds ratio 0.39 (95% confidence interval 0.24-0.64; p=0.0002). The trends of mortality among STEMI were steady (p-trend 0.11). PCI trend increased (p-trend 0.008) and incidence of STEMI decreased over the study years 2012 (0.66%)-2018(0.474%). A total of 84,810 (14.4%) patients were readmitted in 30 days of which 696 (20%) patients were among the STEMI subgroup.
STEMI is not an uncommon complication among KTR and is associated with significant mechanical complications. Improvement in cardiovascular risk factors might improve the STEMI rates among KTR.
关于肾移植受者（KTR）中 ST 段抬高型心肌梗死（STEMI）结局的文献有限。
研究 KTR 中 STEMI 的结局。
分析了 2012 年至 2018 年期间美国全国再入院数据库（NRD）中符合分层样本的所有医院的 49.1%的样本中，KTR 因 STEMI 住院的情况。使用国际疾病分类代码提取与 STEMI 相关的并发症。
2012 年至 2018 年期间，NRD 共记录了 588668 例 KTR 指数住院治疗（平均年龄 57.67±14.22 岁；女性 44.5%），其中 3496 例（0.59%）发生 STEMI。共有 11676 例（1.98%）患者在住院期间死亡。STEMI 患者的院内死亡率较高，为 465 例（13.3%），而非 STEMI 患者为 11211 例（1.92%）。在并发症中，机械并发症发生率为 1.0%，而无 STEMI 组为 0.02%；心源性休克发生率为 10.6%，而非 STEMI 组为 0.3%；室性心律失常发生率为 8.3%，而非 STEMI 组为 0.8%；传导阻滞发生率为 6.9%，而非 STEMI 组为 2%；中风发生率为 4.1%，而非 STEMI 组为 1.9%；急性肾损伤发生率为 31.6%，而非 STEMI 组为 28.3%。在冠状动脉介入治疗中，1999 例（57.2%）进行了冠状动脉造影，其中 1777 例（50.8%）进行了经皮冠状动脉介入治疗（PCI）。在对基线特征进行粗化精确匹配后，PCI 与死亡率的相关性较低，比值比为 0.39（95%置信区间 0.24-0.64；p=0.0002）。STEMI 患者的死亡率趋势保持稳定（p 趋势=0.11）。随着时间的推移，PCI 的趋势增加（p 趋势=0.008），STEMI 的发生率在研究期间从 2012 年（0.66%）下降到 2018 年（0.474%）。在 30 天内，共有 84810 例（14.4%）患者再次入院，其中 696 例（20%）患者为 STEMI 亚组。
STEMI 在 KTR 中并非罕见并发症，且与严重的机械并发症相关。改善心血管危险因素可能会降低 KTR 中的 STEMI 发生率。
