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KMID : 0359920090280010032
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Korean Journal of Nephrology
2009 Volume.28 No. 1 p.32 ~ p.40
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Clinical Characteristics of Acute Myocardial Infarction in Dialysis Patients
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Kim Hyung-Wook
Kim Yong-Soo
Kim Young-Soo
Yoon Sun-Ae
Kim Young-Ok
Chang Se-Na
Hwang Hyeon-Seok
Park Mi-Youn
Yoon Hye-Eun
Yoo Ki-Dong
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Abstract
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Purpose: Cardiovascular disease is the predominant cause of death in patients with end stage renal disease. Approximately 33.7% of overall mortality is due to cardiovascular disease, and about 27% of these cardiovascular deaths are attributed to acute myocardial infarction (AMI). Despite the significance of AMI, there are little data on the clinical characteristics of AMI in dialysis patients.
Methods:Thirty-two dialysis patients admitted for AMI from January 2004 to December 2007 were retrospectively analyzed. One hundred twenty-three AMI patients were included as a control. The clinical and laboratory findings of AMI were compared between dialysis patients and non-dialysis patients.
Results: The frequency of typical chest pain was significantly lower in dialysis patients than in non- dialysis patients (18.8% vs. 62.6%, p<0.001), and typical ECG findings of STEMI were significantly less noted (28.1% vs. 82.9%, p<0.001). Increases in CPK, CK-MB, and troponin T levels were significantly lower in dialysis patients than in non-dialysis patients ( p<0.001). In contrast, dialysis patients revealed more multi-vessel diseases on coronary angiography and more left ventricular hypertrophy and were associated with higher mortality during admission than non-dialysis patients.
Conclusion: Although dialysis patients with AMI had less typical chest pain and typical ECG findings, and had lower increases in cardiac enzyme levels, they revealed more severe coronary vessel diseases than non-dialysis patients. Therefore, efforts for early and accurate diagnosis of AMI are needed in dialysis patients with nonspecific complaints of AMI.
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KEYWORD
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Dialysis, Acute myocardial infarction, Mortality
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