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Kidney Week

Abstract: SA-PO496

Are We Closing the Loop in Patients with ESRD Too Soon?

Session Information

Category: Hypertension and CVD

  • 1602 Hypertension and CVD: Clinical

Authors

  • Gutierrez, Jorge, Lincoln Medical Center, Bronx, New York, United States
  • Johan, Kenneth, Lincoln Medical Center, Bronx, New York, United States
  • Lim, Chee Yao, Lincoln Medical Center, Bronx, New York, United States
  • Romero, Alberto, Lincoln Medical Center, Bronx, New York, United States
  • Patel, Pinal, Lincoln Medical Center, Bronx, New York, United States
  • Matabang, Maria Angela, Lincoln Medical Center, Bronx, New York, United States
  • Afzal, Afsheen, Lincoln Medical Center, Bronx, New York, United States
  • Zain, Rahul, Lincoln Medical Center, Bronx, New York, United States
  • Aggarwal, Richa, Lincoln Medical Center, Bronx, New York, United States
  • Menon, Vidya, Lincoln Medical Center, Bronx, New York, United States
Background

Cardiovascular (CV) disease remains the leading cause of death in ESRD patients. Myocardial infarction (MI) is associated with poorer outcomes compared to the general population. A recent consensus by the Standardized Outcomes in Nephrology Hemodialysis (SONG-HD) group defines MI type I in ESRD patients if they have changes in EKG, symptoms, and a rise or fall of troponin (cTn) within 6 to 12 hours of more than 20% if elevated or more than 50% if normal on admission. We aimed to study the outcomes of patients with ESRD and elevated troponin according to this new consensus.

Methods

This retrospective single center study included patients with ESRD admitted with elevated troponin from April, 2020 to 2022. Patients with a single cTn on admission, repeated cTn less than 6 hours apart from the initial, admitted for cardiac arrest or trauma were excluded. Patients that met criteria for type I MI according to the SONG-HD group consensus were included for the study. Baseline characteristics and mortality up to 1 year were analyzed using descriptive statistics.

Results

After stratifying according to exclusion and inclusion criteria a total of 24 ESRD patients were admitted during this period for type I MI. 4 patients received ACS protocol (ACSP) and PCI within 30 days with a mortality of 0%, 12 patients only ACSP with a mortality of 25% and 8 patients no intervention with a mortality of 50%. 14 patients were documented as type I MI and 10 patients were not due to the lack of guidelines at that time. Out of the 14 patients, 3 received ACSP and PCI within 30 days, with a mortality rate of 0%, 9 only ACSP with a mortality of 11% and 2 received no intervention with a mortality rate of 50%. Out of the 10 patients not identified as type 1 on hospitalization, mortality was 50%.

Conclusion

To date there are no clinical trials about the benefit or harm of revascularization in patients with ESRD. The ISCHEMIA-CKD study reports no benefit in initial invasive strategy when compared to conservative strategy in patients with CKD stage 3 and 4. Though our sample size is small, it brings to light the recurrent question about the role of early cardiac catheterization/PCI among patients with type 1 MI with ESRD while highlighting the importance of early and accurate recognition of type 1 MI in this high risk population.