Cardiac History and Dialysis Duration Associated with Elevated Risk of EAMI

Philadelphia—Kidney transplant recipients with a history of cardiovascular disease and longer duration of dialysis were at increased risk of early post-operative acute myocardial infarction (EAMI) in a study conducted recently by Maya Deeb and colleagues. The researchers reported study results during a poster session at Kidney Week 2014 in a poster titled Early Post-Operative Acute Myocardial Infarction in Kidney Transplant Recipients: Incidence, Risk Factors, and Outcomes.

According to the researchers, there are few data on the epidemiology of acute myocardial infarction early after kidney transplantation. This study was designed to assess the incidence, risk factors, and outcomes of EAMI in a cohort of Canadian kidney transplant recipients.

The study included 1464 patients who underwent kidney transplantation at Toronto General Hospital, Toronto, Ontario, from January 1, 2000, to September 30, 2012. Patients were followed until September 30, 2013.

The study utilized a nested case-control design to study the risk factors associated with EAMI with a conditional logistic regression model. A single cardiologist adjudicated EAMI cases within 3 months post-transplant using the consensus definition set by the American Heart Association. Each case was matched to five controls on follow-up time, year of transplant, and donor type. A Cox proportional hazards model was fitted to the total study cohort to assess the association of EAMI with graft loss and/or death.

Of the kidney transplant recipients, 3.3% (n=49) had an EAMI episode; most (61.2%) occurred within the first 3 days following transplantation. Factors predictive of EAMI were older age (odds ratio [OR], 1.06; 95% confidence interval [CI]; 1.03-1.09), female sex (OR, 0.36; 95% CI, 0.16-0.79); pre-transplant diabetes (OR, 3.91; 95% CI, 2.05-7.45); history of cardiac disease (OR, 8.70; 95% CI, 4.04-18.73); and smoking (OR, 1.97; 95% CI, 1.02-3.80).

Following multivariant adjustment, independently predictive factors for EAMI were history of cardiac disease (OR, 5.11; 95% CI, 2.23-11.73) and longer duration of dialysis (OR, 1.21; 95% CI, 1.07-1.37).

EAMI was associated with significantly elevated relative hazards for total graft failure (hazard ratio [HR], 2.12; 95% CI, 1.24-3.64) and death with graft function (HR, 2.42; 95% CI, 1.27-4.62), but not death-censored graft failure (HR, 1.58; 95% CI 0.61-4.08).

In conclusion, the researchers said, “Patients with a cardiovascular history and longer duration of dialysis were at elevated risk of EAMI. While the incidence of EAMI in kidney transplant recipients is low, it is associated with a significant risk of graft failure (including death).”

Source: Deeb M, Overgaard CB, Li Y, Famure O, Kim J. Early post-operative acute myocardial infarction in kidney transplant recipients: incidence, risk factors, and outcomes. Abstract of poster presented at Kidney Week 2014, Philadelphia, Pennsylvania, November 13, 2014.