PCI Shows Benefits for Dialysis Patients with STEMI

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For dialysis patients with ST-elevation myocardial infarction (STEMI), the benefits of percutaneous coronary intervention (PCI) are similar to those in non-dialysis patients, reports a study in the American Journal of Kidney Diseases.

Using the National Inpatient Sample, the researchers identified 413,500 adult hospitalizations for STEMI between 2016 and 2018. Of these, 4220 hospitalizations were for patients receiving dialysis—a rate of 1.07%. Dialysis patients with STEMI were older (65.2 versus 63.4 years), more likely to be women (42.4% versus 30.6%), and less likely to be White (41.1% versus 71.7%). Dialysis patients also had higher rates of comorbid cardiovascular and non-cardiovascular conditions.

Outcomes were compared for propensity score-matched cohorts of 2425 dialysis patients and 326,725 non-dialysis patients undergoing PCI, as well as 2420 dialysis patients and 325,955 non-dialysis patients who did not undergo PCI. The average treatment effect of PCI was estimated for in-hospital mortality and other outcomes.

Among STEMI patients, those on dialysis were less likely to undergo angiography (73.1% versus 85.4%) and less likely to undergo PCI (57.5% versus 79.8%). PCI was associated with lower mortality among dialysis patients (15.7% versus 27.1%), as well as non-dialysis patients (5.0% versus 17.4%). The average treatment effect was about the same between groups: −8.6% and −8.2%, respectively. The average marginal effect, accounting for clustering within hospitals, was −9.4% versus −7.9%. Other treatment effects of PCI were also similar for dialysis and non-dialysis patients, including major complications and discharge disposition. In both groups, PCI was associated with longer hospital stays and higher costs.

The study confirms that dialysis patients with STEMI are much less likely to undergo PCI compared to non-dialysis patients. However, despite their increased clinical risks, the in-hospital mortality benefit of PCI in dialysis patients appears similar to that for non-dialysis patients. The researchers conclude, “Further studies are needed to optimize STEMI care in the growing dialysis population” [Kawsara A, et al. Treatment effect of percutaneous coronary intervention in dialysis patients with ST-elevation myocardial infarction. Am J Kidney Dis, published online ahead of print October 15, 2021. doi: 10.1053/j.ajkd.2021.08.023; https://www.ajkd.org/article/S0272-6386(21)00922-7/fulltext