Poor long-term survival after acute myocardial infarction among patients on long-term dialysis
Poor long-term survival after acute myocardial infarction among patients on long-term dialysis
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DOI：
10.1056/nejm199809173391203
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发表时间：
1998-09-17
影响因子：
158.5
通讯作者：
Collins, AJ
中科院分区：
文献类型：
--
作者：
Herzog, CA;Ma, JZ;Collins, AJ
心血管疾病在长期透析患者中很常见，占该组总死亡率的44%。我们进行了一项研究，以评估长期透析的美国患者急性心肌梗死后的长期生存率。方法从美国肾脏数据系统数据库中回顾性识别1977年至1995年期间因首次心肌梗死开始肾脏替代治疗后住院的透析患者。总死亡率和心源性死亡率（包括所有住院死亡）采用生命表法进行估计。结果急性心肌梗死后34，189例长期透析患者的总死亡率（+/-SE）为59.3+/-0.3%，2年为73.0+/-0.3%，5年为89.9+/-0.2%。心脏原因的死亡率在一年内为40.8+/-0.3%，2年内为51.8+/-0.3%，5年内为70.2+/-0.4%。年龄较大或患有糖尿病的患者比没有这些特征的患者死亡率更高。甚至在1990年至1995年发生急性心肌梗死的患者中也发生了不良结局。此外，心肌梗死后的死亡率是相当高的长期透析患者比肾移植recipients.Conclusions透析患者谁有急性心肌梗死心脏原因的死亡率高，长期生存率差。（N Engl J Med 1998;339：799-805.）(C)1998年，马萨诸塞州医学会。
Background Cardiovascular disease is common in patients on long-term dialysis, and it accounts for 44 percent of overall mortality in this group. We undertook a study to assess long-term survival after acute myocardial infarction among patients in the United States who were receiving long-term dialysis,Methods Patients on dialysis who were hospitalized during the period from 1977 to 1995 for a first myocardial infarction after the initiation of renal-replacement therapy were retrospectively identified from the U.S. Renal Data System data base. Overall mortality and mortality from cardiac causes (including all in-hospital deaths) were estimated by the life-table method. The effect of independent predictors on survival was examined in a Cox regression model with adjustment for existing illnesses.Results The overall mortality (+/-SE) after acute myocardial infarction among 34,189 patients on long term dialysis was 59.3+/-0.3 percent at one year, 73.0+/-0.3 percent at two years, and 89.9+/-0.2 percent at five years. The mortality from cardiac causes was 40.8+/-0.3 percent at one year, 51.8+/-0.3 percent at two years, and 70.2+/-0.4 percent at five years. Patients who were older or had diabetes had higher mortality than patients without these characteristics. Adverse outcomes occurred even in patients who had acute myocardial infarction in 1990 through 1995. Also, the mortality rate after myocardial infarction was considerably higher for patients on long-term dialysis than for renal-transplant recipients.Conclusions Patients on dialysis who have acute myocardial infarction have high mortality from cardiac causes and poor long-term survival. (N Engl J Med 1998;339:799-805.) (C) 1998, Massachusetts Medical Society.