Genovesi Simonetta, Regolisti Giuseppe, Bonomi Alice, Leoni Olivia, Galotta Arianna, Marenzi Giancarlo
School of Medicine and Surgery, Nephrology Clinic, University of Milano-Bicocca, Monza, Italy.
Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Unità di Cardiologia, Milan, Italy.
Kidney Med. 2025 May 12;7(7):101023. doi: 10.1016/j.xkme.2025.101023. eCollection 2025 Jul.
RATIONALE & OBJECTIVE: Atrial fibrillation (AF) is highly prevalent among patients receiving maintenance hemodialysis (HD) and patients with ST elevation myocardial infarction (STEMI). We investigated the association of AF with in-hospital mortality, 1-year mortality, and 1-year readmission for acute myocardial infarction (AMI) in HD patients admitted with STEMI.
Retrospective cohort study based on a large administrative database.
SETTING & PARTICIPANTS: 138,939 patients admitted with STEMI from 2003-2018, of whom 1,185 (8.5%)receiving HD, followed from the date of admission until death, migration, or 1 year after discharge.
STEMI ( [ICD-9-CM] 410.x) as the primary discharge diagnosis, maintenance HD (ICD-9-CM 39.95; 54.98; V560; V563.1; V563.2), and AF (ICD-9-CM 427.31).
In-hospital all-cause mortality (primary outcome), 1-year all-cause mortality, and 1-year readmission for AMI (secondary outcomes).
Multivariable logistic regression and multivariable Cox regression.
One hundred and ninety-five out of 1,185 (16.5%) patients had AF at admission or developed AF during hospitalization. After adjusting for possible confounders, AF versus sinus rhythm was associated with higher in-hospital mortality (odds ratio [OR] = 1.57; 95% confidence interval [CI], 1.11-2.22). AF was associated with higher 1-year mortality (hazard ratio [HR] = 1.45; 95% CI, 1.18-1.76), whereas it was not associated with higher 1-year readmission for AMI (HR = 1.05; 95% CI, 0.72-1.53). Less than 20% of patients with AF discharged alive were prescribed oral anticoagulant therapy. In this subgroup, oral anticoagulant therapy was associated with lower 1-year mortality (HR = 0.46; 95% CI, 0.24-0.89).
Potential bias due to incorrect or incomplete coding, retrospective design, incidence of thromboembolic events after discharge, and cause of 1-year mortality unknown.
AF is highly prevalent and associated with adverse short- and long-term outcomes in HD patients admitted with STEMI.
心房颤动（AF）在接受维持性血液透析（HD）的患者以及ST段抬高型心肌梗死（STEMI）患者中非常普遍。我们调查了STEMI合并HD患者中AF与住院死亡率、1年死亡率以及急性心肌梗死（AMI）1年再入院率之间的关联。
基于大型行政数据库的回顾性队列研究。
2003年至2018年期间收治的138,939例STEMI患者，其中1,185例（8.5%）接受HD治疗，从入院日期开始随访直至死亡、迁移或出院后1年。
以STEMI（[国际疾病分类第九版临床修订本（ICD-9-CM）]410.x）作为主要出院诊断、维持性HD（ICD-9-CM 39.95；54.98；V560；V563.1；V563.2）以及AF（ICD-9-CM 427.31）。
1,185例患者中有195例（16.5%）在入院时患有AF或在住院期间发生AF。在对可能的混杂因素进行校正后，AF与窦性心律相比与更高的住院死亡率相关（比值比[OR]=1.57；95%置信区间[CI]，1.11-2.22）。AF与更高的1年死亡率相关（风险比[HR]=1.45；95%CI，1.18-1.76），而与AMI的1年再入院率升高无关（HR=1.05；95%CI，0.72-1.53）。出院时存活的AF患者中不到20%接受了口服抗凝治疗。在这个亚组中，口服抗凝治疗与较低的1年死亡率相关（HR=0.46；95%CI，0.24-0.89）。
由于编码错误或不完整、回顾性设计、出院后血栓栓塞事件的发生率以及1年死亡率的原因不明而可能存在偏差。
AF在STEMI合并HD患者中非常普遍，并且与不良的短期和长期预后相关。
