Jose Jayme G De Lima1, Luis Henrique W Gowdak2, Jose Otto Reusing3, Elias David-Neto3, Luiz A Bortolotto2. 1. Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Rua Eneas Carvalho Aguiar 44, São Paulo, SP, 05403-000, Brazil. Jose.lima@incor.usp.br. 2. Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Rua Eneas Carvalho Aguiar 44, São Paulo, SP, 05403-000, Brazil. 3. Renal Transplant Unit, Urology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, Brazil.
Abstract
BACKGROUND: The incidence of myocardial infarction (MI) is elevated in patients receiving renal replacement therapy (RRT). We hypothesized that an invasive strategy of assessment of coronary artery disease (CAD) will identify patients more prone to developing MI. METHODS: This was a single-center observational cohort study that included 1678 patients receiving RRT (hemodialysis and renal transplantation) assessed for CAD prospectively and analyzed retrospectively. Endpoints were the incidence of MI and death. RESULTS: The median follow-up was 43 months, and 180 patients experienced an MI with a mortality rate of 74%. Multivariate analysis showed that diabetes (HR 1.633; 95% CI 1.165-2.289), prior MI (HR 1.724; 95% CI 1.153-2.579), and CAD (HR 2.073; 95% CI 1.400-3.071) were predictors of MI. Altered myocardial scan did not correlate with MI. At the discretion of the attending physicians, 20/180 patients (11%) underwent coronary intervention that was associated with a higher cumulative survival (Log-rank 0.007). CONCLUSION: Patients with CAD suffered an MI more frequently, independently of symptoms and risk factors for MI, including noninvasive testing. Because of the elevated rate of the lethality of MI, invasive coronary studies may be indicated in select patients on RRT. Once an MI occurs, our data suggest that an invasive therapeutic approach is warranted.
BACKGROUND: The incidence of myocardial infarction (MI) is elevated in patients receiving renal replacement therapy (RRT). We hypothesized that an invasive strategy of assessment of coronary artery disease (CAD) will identify patients more prone to developing MI. METHODS: This was a single-center observational cohort study that included 1678 patients receiving RRT (hemodialysis and renal transplantation) assessed for CAD prospectively and analyzed retrospectively. Endpoints were the incidence of MI and death. RESULTS: The median follow-up was 43 months, and 180 patients experienced an MI with a mortality rate of 74%. Multivariate analysis showed that diabetes (HR 1.633; 95% CI 1.165-2.289), prior MI (HR 1.724; 95% CI 1.153-2.579), and CAD (HR 2.073; 95% CI 1.400-3.071) were predictors of MI. Altered myocardial scan did not correlate with MI. At the discretion of the attending physicians, 20/180 patients (11%) underwent coronary intervention that was associated with a higher cumulative survival (Log-rank 0.007). CONCLUSION: Patients with CAD suffered an MI more frequently, independently of symptoms and risk factors for MI, including noninvasive testing. Because of the elevated rate of the lethality of MI, invasive coronary studies may be indicated in select patients on RRT. Once an MI occurs, our data suggest that an invasive therapeutic approach is warranted.
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Authors: Carmen Sánchez-Perales; Eduardo Vázquez-Ruiz de Castroviejo; Pilar Segura-Torres; Francisco Borrego-Utiel; M José García-Cortés; Francisco García-García; M Mar Biechy-Baldan; José M Gil-Cunquero; Antonio Liébana-Cañada Journal: Nefrologia Date: 2012 Impact factor: 2.033
Authors: Joalbo M Andrade; Luís Henrique W Gowdak; Maria C P Giorgi; Flavio J de Paula; Roberto Kalil-Filho; José Jayme G de Lima; Carlos E Rochitte Journal: AJR Am J Roentgenol Date: 2009-07 Impact factor: 3.959