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Aspirin, beta-blocker, and angiotensin-converting enzyme inhibitor therapy in patients with end-stage renal disease and an acute myocardial infarction.
J Am Coll Cardiol. 2003 Jul 16; 42(2):201-8.JACC

Abstract

OBJECTIVES

We sought to examine the use and impact of standard medical therapies in patients with end-stage renal disease (ESRD) faced with an acute myocardial infarction (AMI).

BACKGROUND

The poor prognosis of patients in this high-risk population has become increasingly well recognized.

METHODS

Using the ESRD database and the Cooperative Cardiovascular Project (CCP) database, we identified AMI patients who were receiving either peritoneal dialysis or hemodialysis before admission. The early administration of aspirin and beta-blockers was compared between ESRD and non-ESRD patients and the effect of these therapies on 30-day mortality was evaluated with logistic regression models.

RESULTS

The cohort consisted of 145,740 patients without ESRD and 1,025 patients with ESRD. Aspirin (67.0% vs. 82.4%, p < 0.001), beta-blockers (43.2% vs. 50.8%, p < 0.001), and angiotensin-converting enzyme (ACE) inhibitors (38.5% vs. 60.3%, p < 0.001) were less likely to be administered to ESRD patients than to non-ESRD patients. The benefit of these therapies on 30-day mortality was similar among ESRD patients (aspirin: relative risk [RR] 0.64; 95% confidence interval [CI] 0.50 to 0.80; beta-blocker: RR 0.78; 95% CI 0.60 to 0.99; ACE inhibitor: RR 0.58; 95% CI 0.42 to 0.77) and non-ESRD patients (aspirin: RR 0.57; 95% CI 0.55 to 0.58; beta-blocker: RR 0.70; 95% CI 0.68 to 0.72; ACE inhibitor: RR 0.64; 95% CI 0.63 to 0.66).

CONCLUSIONS

End-stage renal disease patients are far less likely than non-ESRD patients to be treated with aspirin, beta-blockers, and ACE inhibitors during an admission for AMI. The lower rates of usage for these medications, particularly aspirin, may contribute to the increased 30-day mortality. These findings demonstrate a marked opportunity to improve care in this population.

Authors+Show Affiliations

Section of Cardiovascular Medicine, Department of Medicine, Minneapolis, Minnesota, USA. berger1217@aol.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12875751

Citation

Berger, Alan K., et al. "Aspirin, Beta-blocker, and Angiotensin-converting Enzyme Inhibitor Therapy in Patients With End-stage Renal Disease and an Acute Myocardial Infarction." Journal of the American College of Cardiology, vol. 42, no. 2, 2003, pp. 201-8.
Berger AK, Duval S, Krumholz HM. Aspirin, beta-blocker, and angiotensin-converting enzyme inhibitor therapy in patients with end-stage renal disease and an acute myocardial infarction. J Am Coll Cardiol. 2003;42(2):201-8.
Berger, A. K., Duval, S., & Krumholz, H. M. (2003). Aspirin, beta-blocker, and angiotensin-converting enzyme inhibitor therapy in patients with end-stage renal disease and an acute myocardial infarction. Journal of the American College of Cardiology, 42(2), 201-8.
Berger AK, Duval S, Krumholz HM. Aspirin, Beta-blocker, and Angiotensin-converting Enzyme Inhibitor Therapy in Patients With End-stage Renal Disease and an Acute Myocardial Infarction. J Am Coll Cardiol. 2003 Jul 16;42(2):201-8. PubMed PMID: 12875751.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Aspirin, beta-blocker, and angiotensin-converting enzyme inhibitor therapy in patients with end-stage renal disease and an acute myocardial infarction. AU - Berger,Alan K, AU - Duval,Sue, AU - Krumholz,Harlan M, PY - 2003/7/24/pubmed PY - 2003/8/21/medline PY - 2003/7/24/entrez SP - 201 EP - 8 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 42 IS - 2 N2 - OBJECTIVES: We sought to examine the use and impact of standard medical therapies in patients with end-stage renal disease (ESRD) faced with an acute myocardial infarction (AMI). BACKGROUND: The poor prognosis of patients in this high-risk population has become increasingly well recognized. METHODS: Using the ESRD database and the Cooperative Cardiovascular Project (CCP) database, we identified AMI patients who were receiving either peritoneal dialysis or hemodialysis before admission. The early administration of aspirin and beta-blockers was compared between ESRD and non-ESRD patients and the effect of these therapies on 30-day mortality was evaluated with logistic regression models. RESULTS: The cohort consisted of 145,740 patients without ESRD and 1,025 patients with ESRD. Aspirin (67.0% vs. 82.4%, p < 0.001), beta-blockers (43.2% vs. 50.8%, p < 0.001), and angiotensin-converting enzyme (ACE) inhibitors (38.5% vs. 60.3%, p < 0.001) were less likely to be administered to ESRD patients than to non-ESRD patients. The benefit of these therapies on 30-day mortality was similar among ESRD patients (aspirin: relative risk [RR] 0.64; 95% confidence interval [CI] 0.50 to 0.80; beta-blocker: RR 0.78; 95% CI 0.60 to 0.99; ACE inhibitor: RR 0.58; 95% CI 0.42 to 0.77) and non-ESRD patients (aspirin: RR 0.57; 95% CI 0.55 to 0.58; beta-blocker: RR 0.70; 95% CI 0.68 to 0.72; ACE inhibitor: RR 0.64; 95% CI 0.63 to 0.66). CONCLUSIONS: End-stage renal disease patients are far less likely than non-ESRD patients to be treated with aspirin, beta-blockers, and ACE inhibitors during an admission for AMI. The lower rates of usage for these medications, particularly aspirin, may contribute to the increased 30-day mortality. These findings demonstrate a marked opportunity to improve care in this population. SN - 0735-1097 UR - https://www.unboundmedicine.com/medline/citation/12875751/Aspirin_beta_blocker_and_angiotensin_converting_enzyme_inhibitor_therapy_in_patients_with_end_stage_renal_disease_and_an_acute_myocardial_infarction_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735109703005722 DB - PRIME DP - Unbound Medicine ER -