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Medientyp:
E-Artikel
Titel:
Treatments and Mortality Trends in Cases With and Without Dialysis Who Have an Acute Myocardial Infarction : An 18-Year Nationwide Experience
:
An 18-Year Nationwide Experience
Beteiligte:
Szummer, Karolina;
Lindhagen, Lars;
Evans, Marie;
Spaak, Jonas;
Koul, Sasha;
Åkerblom, Axel;
Carrero, Juan Jesus;
Jernberg, Tomas
Beschreibung:
<jats:sec>
<jats:title>Background:</jats:title>
<jats:p>Patients on dialysis who have an acute myocardial infarction (AMI) have an exceedingly poor prognosis, but it is unknown to what extent guideline-recommended interventions and treatments are used and to which benefit. We aimed to assess temporal changes in the use of treatments and survival rates in dialysis patients with an AMI.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods and Results:</jats:title>
<jats:p>
All consecutive AMI cases from 1996 to 2013 enrolled in the SWEDEHEART registry (Swedish Web–System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) were included. The Swedish Renal Registry identified all chronic dialysis cases. Multivariable adjusted standardized 1-year mortality was estimated. An age-sex-calendar year–matched dialysis background population from the Swedish Renal Registry was used to obtain a standardized incidence ratio. All analyses were performed in 2-year blocks, where each individual could be included several times but in different time blocks; hence the term AMI cases and not patients is used. Of 289 699 cases with AMI, 1398 (0.5%) were on dialysis (73.6% hemodialysis; 26.4% peritoneal dialysis). Among dialysis cases, 29.4% were women, and 21.0% had ST-segment–elevation myocardial infarction. Through 1996 to 2013, dialysis cases had similar age (median, 70 years [interquartile range, 62–77];
<jats:italic>P</jats:italic>
for trend, 0.14), but the proportion with diabetes mellitus increased (36.0%–55.3%;
<jats:italic>P</jats:italic>
for trend, 0.005). Dialysis cases admitted with AMI were treated more invasively and received more discharge medications in the later years. From 1995 to 2013, in-hospital and 1-year mortality decreased from 25.4% to 9.4% and from 59.6% to 41.2%, respectively. The standardized in-hospital and 1-year mortality decreased from 25.7% to 9.4% and from 54.6% to 41.2%. Yet, compared with the matched dialysis population, the odds of death remained as high in 2012/2013 as in 1996/1997 (odds ratio, 2.04; 95% CI, 1.62–2.58 and odds ratio, 1.99; 95% CI, 1.52–2.60, respectively;
<jats:italic>P</jats:italic>
for trend, 0.34).
</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusions:</jats:title>
<jats:p>Over the last 18 years, more patients on dialysis with AMI have been treated with evidence-based therapies. Overall, dialysis cases with AMI have an improved in-hospital and 1-year survival in the more recent years compared with earlier years. However, this appears largely to be because of improved survival in the general dialysis population.</jats:p>
</jats:sec>