Management of acute myocardial infarction in chronic kidney disease in Germany: an observational study.

Abstract

Background: Managing acute myocardial infarction (AMI) in patients with chronic kidney disease (CKD) or end-stage renal disease on dialysis (renal replacement therapy, RRT) presents challenges due to elevated complication risks. Concerns about contrast-related kidney damage may lead to the omission of guideline-directed therapies like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in this population.

Methods: We analysed German-DRG data of 2016 provided by the German Federal Bureau of Statistics (DESTATIS). We included cases with a primary diagnosis of AMI (ST-Elevation Myocardial Infarction (STEMI) or Non-ST-Elevation Myocardial Infarction (NSTEMI) ICD-10: I21 or I22) with and without CKD or RRT. We calculated crude- and age-standardized hospitalization rates (ASR, per 100,000 person years). Furthermore, we calculated log-binominal regression models adjusting for sex, CKD, RRT, comorbidities, and place of residence to estimate adjusted relative-risks (aRR) for receiving treatments of interest in AMI, such as PCI or CABG.

Results: We identified 217,514 AMI-cases (69,728 STEMI-cases and 147,786 NSTEMI-cases). AMI-cases without CKD had percutaneous coronary intervention (PCI) in 60.8%. In contrast, AMI-cases with CKD or RRT had PCI in 46.6% and 54.5%, respectively. The ASR for AMI-cases amounted to 184.7 (95%CI 183.5-185.8) per 100,000 person years. In regression analysis AMI-cases with CKD were less likely treated with PCI (aRR: 0.89 (95%CI 0.88-0.90)), compared to cases without CKD. AMI-Cases with RRT showed no difference in PCI rates (aRR: 1.0 (95%CI 0.97-1.03)) but were more frequently treated with CABG (aRR: 2.20 (95%CI 2.03-2.39)). Conversely, CKD was negatively associated with CABG (aRR: 0.71, 95%CI 0.67-0.75) when non-CKD cases were used as the reference group.

Conclusion: We show that AMI-cases with CKD underwent PCI less frequently, while RRT has no discernible impact on PCI utilization in AMI. Furthermore, AMI-cases with RRT exhibited a higher CABG rate.