Underutilization of left heart catheterization in kidney transplant patients presenting with non-ST segment elevation myocardial infarction

Ahmad Mustafa; Samer Asmar; Chapman Wei; John Afif; Shahkar Khan; Taqi Rizvi; Radu Grovu; Mitchell Weinberg; Suzanne El-Sayegh

doi:10.1016/j.ahjo.2023.100300

Underutilization of left heart catheterization in kidney transplant patients presenting with non-ST segment elevation myocardial infarction

Am Heart J Plus. 2023 May 4:30:100300. doi: 10.1016/j.ahjo.2023.100300. eCollection 2023 Jun.

Authors

Ahmad Mustafa^{1

2}, Samer Asmar¹, Chapman Wei¹, John Afif¹, Shahkar Khan¹, Taqi Rizvi¹, Radu Grovu¹, Mitchell Weinberg², Suzanne El-Sayegh³

Affiliations

¹ Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA.
² Department of Cardiology, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA.
³ Department of Nephrology, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA.

Abstract

Background: Cardiovascular disease (CVD) is the leading cause of mortality in kidney transplant (KT) patients. The perceived risk of contrast-induced nephropathy (CIN) may create a reluctance to perform coronary angiography in patients presenting with non-ST segment elevation myocardial infarction (NSTEMI).

Methods: National Inpatient Sample (NIS) Database was used to sample individuals presenting with NSTEMI. Patients were stratified into KT and Non-KT cohorts. Outcomes included left heart catheterization rates, mortality, arrhythmias, acute kidney injury/acute renal failure (AKI/ARF), and extended length of hospital stay (ELOS) (>72 h). Propensity matching (1:1 ratio) and regression analyses were performed.

Results: Out of 336,354 patients with NSTEMI, 742 patients were in the KT group. KT patients were less likely to have LHC relative to non-KT patients (22.0 % vs 18.3 %); a difference that persisted on post-match analysis (27.1 % vs 19.4 %). On pre-match analysis, KT transplant patients that underwent LHC had lower mortality (10.3 % vs 0.7 %), AKI/ARF (44.6 % vs 27.9 %), arrhythmias (30.4 % vs 20.6 %) and lower ELOS (58.6 % vs 41.9 %). Post-match, KT cohort patient that underwent LHC had lower arrhythmias (OR:0.60[0.38-0.96]), AKI/ARF (OR = 0.51[0.34-0.77]), ELOS (OR:0.49[0.34-0.73]).

Conclusion: KT patients underwent LHC much less frequently than their non-KT counterparts for NSTEMI. Coronary angiography and subsequent revascularization were associated with a significant decrease in morbidity and mortality. This theorized risk of CIN should not outweigh the benefit of LHC in KT patients.

Keywords: Kidney transplant (KT); Left heart catheterization (LHC); Non-ST segment elevation myocardial infarction (NSTEMI).