Surgical revascularization after acute myocardial infarction in patients with end-stage renal disease.

OBJECTIVE

Cardiovascular disease accounts for over 50% of deaths in patients with end-stage renal disease (ESRD). After acute myocardial infarction (AMI), hospital mortality exceeds 25%, and survival beyond 2 years is <20% for patients with ERSD. The role of coronary artery bypass grating (CABG) in the setting of an AMI in patients with ESRD remains undefined.

METHODS

Three hundred and forty-two patients had preoperative ESRD (serum creatinine >2.0mg/dl or dialysis dependence) between 1995 and 2000. One hundred and nineteen patients had an AMI (<7 days) and 223 patients had a remote myocardial infarction (RMI) (>7 days) at the time of CABG. The study group, AMI, was compared to the RMI group, which served as a comparison group.

RESULTS

The age (69 vs. 67 years), males (68 vs. 67%), creatinine (3.18 vs. 3.76 mg/dl, P=0.06), and preoperative dialysis (19 vs. 22%, P=0.52) were similar in either the AMI or RMI group, respectively. The frequency of diabetes, hypertension, dyslipidemia, previous myocardial infarction were common, yet not different between groups (P=NS). For either AMI or RMI group, multivessel CABG (96 vs. 94%, P=0.73), off-pump CABG (OPCAB) (22 vs. 18%, P=0.67), and arterial conduits (71 vs. 78%, P=0.42) were similar. Among postoperative events, only pulmonary complications (33.8 vs. 14.7%, P=0.049) and atrial fibrillation (48 vs. 29%, P<0.001) were more common in the AMI group. Hospital mortality was no different between the AMI and RMI groups (10 vs. 8.5%, P=0.88).

CONCLUSIONS

Although patients with ESRD that have an AMI or RMI represent high risk groups, perioperative outcomes suggest that patients selected for CABG as an early treatment strategy in the setting of an AMI represents a viable therapeutic option.