Abstract: SA-PO495
Are We Dismissing Type 2 Myocardial Infarction (MI) in ESRD? A Serious Note of Concern
Session Information
- Hypertension and CVD: Clinical - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Gutierrez, Jorge, Lincoln Medical Center, Bronx, New York, United States
- Lim, Chee Yao, Lincoln Medical Center, Bronx, New York, United States
- Johan, Kenneth, 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
- Zain, Rahul, Lincoln Medical Center, Bronx, New York, United States
- Afzal, Afsheen, Lincoln Medical Center, Bronx, New York, United States
- Matabang, Maria Angela, Lincoln Medical Center, Bronx, New York, United States
- Sinanova, Betina, Lincoln Medical Center, Bronx, New York, United States
- Ategeka, Julian, Lincoln Medical Center, Bronx, New York, United States
- Yip, Laverne, Lincoln Medical Center, Bronx, New York, United States
- Soe, May, Lincoln Medical Center, Bronx, New York, United States
- Wahab, Abdul, 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
Patients with ESRD and elevated troponin (cTn) have increased morbidity and mortality. The cTn elevation is often overlooked and categorized as chronic cTn elevation or demand ischemia. We aim to evaluate 30-day readmission and mortality at one year among hospitalized ESRD patients.
Methods
Adult patients with ESRD and elevated cTn admitted from 4/2020 to 4/2022 were included. The 4th Universal Definition of MI and cTn change ≥20% in patients with elevated cTn on admission were used to identify type 1 MI in ESRD. Patients were stratified into 2 groups: type 1 and type 2 MI. 30 days readmission rate and mortality during admission & 1 year were analyzed.
Results
Of the 376 patients hospitalized, 168 were classified as Type 1 or 2 MI and the rest were determined to have chronic elevation of cTn. 24 were classified as type 1 and 144 as type 2. Baseline characteristics were similar between both groups. 30 days readmission rate was 21% in the type 1 group vs 18% in the type 2 (p= 0.745). Mortality during hospitalization was 21% for type 1 vs 9% for type 2 (p= 0.083). Mortality was comparable at 1 year: 29% for type 1 vs 17% in Type 2. Risk of mortality in type 2 MI was higher with heart failure (OR 4.121, p=0.041), afib (OR 6.684, p=0.031) and hemoglobin <8 (OR 9.023, p=0.007). Patients with CVA (OR 0.080, p=0.010), chest pain on admission (OR 0.097, p=0.006), and atypical symptoms (OR 0.079, p=0.016) had better survival.
Conclusion
Type 2 MI is more common among ESRD patients. It has comparable outcomes at one year to type 1, highlighting the importance of strategies to accurately diagnose and risk stratify for better outcomes. Further research in this area, including the role of intervention, will enhance our understanding and improve clinical practices for this vulnerable population excluded in the ISCHEMIA-CKD trial.