MedicalResearch.com Interview with:
Tanush Gupta, MD
Department of Medicine, Division of Cardiology
New York Medical College, NY
Medical Research: What is the background for this study? What are the main findings?
Dr. Gupta: There are approximately 600,000 prevalent cases of end stage renal disease (ESRD) in the United States. Cardiovascular disease is the leading cause of death in ESRD patients. Moreover, approximately 20% of these deaths due to cardiovascular disease are attributable to acute myocardial infarction (AMI). Multiple studies have shown that ESRD patients have poor short- and long-term survival after AMI relative to the general population. We analyzed the publicly available Nationwide Inpatient Sample (NIS) databases from 2003 to 2011 to examine the temporal trends in ST-elevation myocardial infarction (STEMI), use of mechanical revascularization for STEMI, and in-hospital outcomes in adult ESRD patients in the United States.
We found that from 2003 to 2011, whereas the number of acute myocardial infarction hospitalizations in ESRD patients increased from 13,322 to 20,552, there was a decline in the number of STEMI hospitalizations from 3,169 to 2,558. The use of percutaneous coronary intervention (PCI) for STEMI increased from 18.6% to 37.8%, whereas there was no significant change in the use of coronary artery bypass grafting. During the study period, in-hospital mortality in ESRD patients with STEMI increased from 22.3% to 25.3%. We also observed an increase in average hospital charges and a decrease in mean length of stay during the study period.
Medical Research: What should clinicians and patients take away from your report?
Dr. Gupta:: ESRD patients comprise a very sick sub-group of the overall STEMI population and are often managed sub-optimally with lower use of revascularization and proven medical therapies. In this analysis, although we observed favorable trends in the use of PCI and length of stay, there was a temporal increase in in-hospital mortality. The increasing trend in in-hospital mortality in ESRD patients with STEMI is worrisome and is in stark contrast to the trends in outcomes of STEMI in the general population, where in-hospital mortality has decreased dramatically in the modern era of reperfusion therapy.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Gupta: Reversal of the above mentioned adverse trends in in-hospital mortality in ESRD patients with STEMI should be the focus of future investigations.
Gupta T, Harikrishnan P, Kolte D, Khera S, Subramanian KS, Mujib M, Masud A, Palaniswamy C, Sule S, Jain D, Ahmed A, Lanier GM, Cooper HA, Frishman WH, Bhatt DL, Fonarow GC, Panza JA, Aronow WS. Trends in Management and Outcomes of ST-Elevation Myocardial Infarction in Patients With End Stage Renal Disease in the United States. Am J Cardiol 2015;115:1033-1041.
MedicalResearch.com Interview with: Tanush Gupta, MD (2015). Heart Attack Carries Worse Prognosis In Dialysis Patients