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Prognosis of acute myocardial infarction in patients on hemodialysis stratified by Killip classification in the modern interventional era (focus on the prognosis of Killip class 1)

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Abstract

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

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Acknowledgements

We thank Medical English Service (https://www.med-english.com/proofreading), for editing a draft of this manuscript.

Funding

Mie ACS registry was funded by incorporated nonprofit organization ' Mie cardiovascular and renal disease network. (http://www.medic.mie-u.ac.jp/miecrnet/) MIE-CARE HD study was funded in part by Suzuken Memorial Foundation, Japan.

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Authors and Affiliations

  1. Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan

    Akihiro Takasaki, Tairo Kurita, Yosuke Hirabayashi, Kan Katayama, Masaaki Ito & Kaoru Dohi

  2. Department of Nephrology, Suzuka Kaisei Hospital, Suzuka, Japan

    Hiroshi Matsuo

  3. Department of Nephrology, Murase Hospital, Suzuka, Japan

    Akiko Tanoue

  4. Department of Cardiology, Mie Prefectural General Medical Center, Yokkaichi, Japan

    Jun Masuda

  5. Department of Cardiology, Yokkaichi Hazu Medical Center, Yokkaichi, Japan

    Takashi Yamanaka

  6. Department of Nephrology, Takeuchi Hospital, Tsu, Japan

    Hirofumi Machida

  7. Department of Cardiology, Kuwana City Medical Center, Kuwana, Japan

    Takehiko Ichikawa

Authors
  1. Akihiro Takasaki
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  2. Tairo Kurita
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  3. Yosuke Hirabayashi
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  4. Hiroshi Matsuo
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  5. Akiko Tanoue
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  6. Jun Masuda
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  7. Takashi Yamanaka
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  9. Hirofumi Machida
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  10. Takehiko Ichikawa
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  11. Masaaki Ito
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  12. Kaoru Dohi
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Corresponding author

Correspondence to Tairo Kurita.

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Conflict of interest

Kaoru Dohi received lecture fees equal to or more than 1000,000 yen from Otsuka Pharma Inc. and departmental research grant support equal to or more than 1,000,000 yen from Otsuka Pharmaceutical Co., Ltd.in 2020. Kaoru Dohi received lecture fee equal to or more than 1,000,000 yen from Otsuka Pharmaceutical Co., Ltd in 2019. Kaoru Dohi received lecture fee equal to or more than 500,000 yen from Otsuka Pharmaceutical Co., Ltd and Takeda Pharmaceutical Company Limited in 2018. Masaki Ito received departmental research grant support equal to or more than 1,000,000 yen from Otsuka Pharmaceutical Co., Ltd. in 2019. Masaki Ito received lecture fees equal to or more than 500,000 yen from Daiichi Sankyo Co., Ltd. in 2019. Masaaki Ito received departmental research grant support equal to or more than 1,000,000 yen from Otsuka Pharma Inc. and Daiichi, Sankyo Company Limited in 2018. Takasaki Akihiro, Tairo Kurita, Yosuke Hirabayashi, Hiroshi Matsuo, Akiko Tanoue, Jun Masuda, Takashi Yamanaka, Kan Katayama, Hirofumi Machida, and Takehiko Ichikawa have no financial conflicts of interest to disclose concerning this study.

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Takasaki, A., Kurita, T., Hirabayashi, Y. et al. Prognosis of acute myocardial infarction in patients on hemodialysis stratified by Killip classification in the modern interventional era (focus on the prognosis of Killip class 1). Heart Vessels 37, 208–218 (2022). https://doi.org/10.1007/s00380-021-01919-7

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  • DOI: https://doi.org/10.1007/s00380-021-01919-7

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