ISCHEMIC HEART DISEASE AND END STAGE RENAL DISEASE

心血管死亡率是慢性病患者死亡的主要原因。 血液透析患者随着人口的持续增长， 由于越来越多的老年人， 接受治疗的终末期肾病（ESRD）和糖尿病患者 肾病，它成为越来越多的缺血性心脏病患者 使用美国肾脏数据系统的ESRD。的 第一个目标是描述发病率的临床决定因素 急性心肌梗死患者的死亡率 血液透析。令人惊讶的是，没有发表的研究报告的死亡率 急性心肌梗死（MI）的发生率在一个大的慢性人群中， 血液透析患者（未检查治疗结局），以及近期 溶栓试验排除了这些患者。为此该 慢性血液透析中急性心肌梗死的总体住院死亡率 将对患者进行评估，并注意检查临床 结果的决定因素。将对以下各项进行类似的单独分析： 肾移植患者 本研究的第二个目的是检查 ESRD患者，尤其是长期血液透析患者， 冠状动脉血运重建手术。以前发表的报告 关注的是一小群 接受经皮冠状动脉腔内成形术（PTCA）的ESRD患者 或冠状动脉旁路手术（CABG）。的发病率和死亡率 冠状动脉血运重建术（PTCA或CABG）和临床 影响结果的因素，将在一个大的人群中进行分析， 使用美国肾脏数据系统的ESRD患者 将对长期透析和肾移植患者进行分析 分开 文献中报告的患者总数 阅读本研究中提出的两个问题， 非常小。对此前公布的数据的解读是 由于“单中心偏见”而变得复杂--小系列的租赁可能 不准确地反映了ESRD人群的真实临床经验 逍遥法外使用美国肾脏数据系统， 与AMI相关的发病率和死亡率的代表性， 终末期肾病患者与冠状动脉血运重建结局 该患者群体应该可以接受手术。

Cardiovascular mortality is the predominant cause of death in chronic hemodialysis patients. With the continuing expansion of a population at significant cardiac risk, due to an increasingly larger number of older patients with treated end stage renal disease (ESRD) and diabetic nephropathy, it becomes increasingly of ischemic heart disease in patients with ESRD.The with ESRD utilizing the United States Renal Data System. The first objective is to characterize the clinical determinants of morbidity and mortality of acute myocardial infarction in patients on chronic hemodialysis. Surprisingly, no published study has reported the mortality rate of acute myocardial infarction (MI) in a large population of chronic hemodialysis patients (nor examined therapeutic outcomes), and recent thrombolytic trials have excluded these patients. For this reason, the overall in-hospital mortality rate of acute MI in chronic hemodialysis patients will be estimated, with attention to examination of clinical determinants of outcome. A similar separate analysis will be performed for patients with renal transplants. The second objective of this study is to examine the clinical outcome of patients with ESRD, particularly patients on chronic hemodialysis, having coronary artery revascularization procedures. Previous published reports have focused on results of coronary revascularization in small groups of ESRD patients having percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass surgery (CABG). The morbidity and mortality of coronary artery revascularization procedures (PTCA or CABG) and clinical factors affecting outcome, will be analyzed in a large population of patients with ESRD using the United States Renal Data System Patients on chronic dialysis and those with renal transplants will be analyzed separately. The total number of patients who have been reported in the literature in reads to the two questions posed in this proposed study has been exceedingly small. The interpretation of previously published data is complicated by "single center bias"- the renting of small series may inaccurately reflect the true clinical experience of the ESRD population at large. Using the United States Renal Data System, a more accurate representation of the morbidity and mortality associated with AMI in patients with ESRD and the outcome of coronary artery revascularization procedures in this patient population should be attainable.