Cardiovascular events and death are more prevalent in hemodialysis (HD) patients than in the general population. However, a detailed prognostic risk stratification of HD patients with acute myocardial infarction (AMI) has not yet been performed in the modern interventional era. We examined 4509 AMI patients (89 AMI/HD and 4420 AMI/non-HD) from the Mie ACS registry and detailed prognostic analyses based on the Killip classification were performed (Cohort A). In addition, prognosis of Killip class1 AMI/HD was compared with those of 313 non-AMI/HD patients from the MIE-CARE HD study using propensity score-matching method (Cohort B). Primary endpoint was all-cause mortality for up to 2 years. All-cause death occurred in 13.0% of AMI/non-HD and 35.8% of AMI/HD during follow-up, and patients with Killip class 1 had lower 30-day and 2-year mortality than those with Killip class ≥ 2 in both AMI/non-HD and AMI/HD. Cox regression analyses identified that Killip class ≥ 2 was the strongest independent prognostic factor of 30-day mortality with a hazard ratio of 7.44 (p < 0.001), whereas both presence of HD and Killip class ≥ 2 were the independent prognostic factors of mortality for up to 2 years. In Cohort B, a propensity score-matching analysis revealed similar all-cause mortality rates between Killip class 1 AMI/HD and non-AMI/HD. In HD patients with Killip class 1 AMI, 30-day mortality was around 6%, and long-term mortality among 30-day survivors after AMI was comparable with the natural course of HD patients in the modern interventional era. Clinical trial registration: URL: https://www.umin.ac.jp/ctr/index-j.htm. UMIN000036020 and UMIN000008128

心血管事件和死亡在血液透析 (HD) 患者中比在一般人群中更为普遍。然而，在现代介入时代尚未对患有急性心肌梗死 (AMI) 的 HD 患者进行详细的预后风险分层。我们检查了来自 Mie ACS 登记的 4509 名 AMI 患者（89 名 AMI/HD 和 4420 名 AMI/非 HD），并根据 Killip 分类进行了详细的预后分析（队列 A）。此外，使用倾向评分匹配法（队列 B）将 Killip 1 类 AMI/HD 的预后与来自 MIE-CARE HD 研究的 313 名非 AMI/HD 患者的预后进行了比较。主要终点是长达 2 年的全因死亡率。随访期间全因死亡发生率为 13.0% 的 AMI/非 HD 和 35.8% 的 AMI/HD，在 AMI/非 HD 和 AMI/HD 中，Killip 1 级患者的 30 天和 2 年死亡率均低于 Killip ≥ 2 级的患者。Cox 回归分析发现，Killip ≥ 2 级是 30 天死亡率最强的独立预后因素，风险比为 7.44（p  < 0.001），而 HD 和 Killip 分级 ≥ 2 是长达 2 年死亡率的独立预后因素。在队列 B 中，倾向评分匹配分析显示 Killip 1 级 AMI/HD 和非 AMI/HD 之间的全因死亡率相似。在具有 Killip 1 级 AMI 的 HD 患者中，30 天死亡率约为 6%，AMI 后 30 天幸存者的长期死亡率与现代介入时代 HD 患者的自然病程相当。临床试验注册：网址：https://www.umin.ac.jp/ctr/index-j.htm。UMIN000036020 和 UMIN000008128