PCI yields short-term mortality gains in STEMI patients receiving dialysis

Primary percutaneous coronary intervention (pPCI) is as good as conservative management in terms of the benefit for in-hospital mortality among ST-segment elevation myocardial infarction (STEMI) patients receiving maintenance dialysis, a study has found.

The study used data from the National-Inpatient-Sample (2016-2018) and included all adult hospitalizations with a primary diagnosis of STEMI. Researchers estimated the average treatment effect of pPCI using propensity score matching within end-stage renal disease (ESRD) and non-ESRD groups, while they calculated the average marginal effect by accounting for the clustering within hospitals.

Out of the 413,500 hospitalizations included in the analysis, 4,220 (1.07 percent) were for patients receiving dialysis. Compared with nondialysis controls, patients on dialysis were older (mean age 65.2 vs 63.4 years; p<0.001), more likely to be female (42.4 percent vs 30.6 percent p<0.001), and had more comorbidities.

Additionally, patients receiving dialysis were less likely to undergo angiography (73.1 percent vs 85.4 percent; p<0.001) or pPCI (57.5 percent vs 79.8 percent; p<0.001). PPCI conferred a lower risk of in-hospital mortality both in the dialysis (15.7 percent vs 27.1 percent; p<0.001) and nondialysis groups (5.0 percent vs 17.4 percent p<0.001).

The average treatment effect on mortality was not significantly different between the dialysis group (–8.6 percent; p=0.02) and the nondialysis group (–8.2 percent; p<0.001). Results for the average marginal effect were also similar in the two groups (–9.4 percent; p<0.001 and –7.9, respectively)

The study was limited by the use of administrative data, the lack of pharmacotherapy and long-term outcome data, and residual confounding.