Percutaneous Coronary Intervention for Acute Coronary Syndrome in Young Adults on Dialysis: Insights From Houston Methodist Young ACS-PCI Registry.

Abstract

AMI and coronary intervention in patients undergoing dialysis are associated with poor survival outcomes. Despite a downward trend in the overall incidence of MI, the incidence among young adults is on the rise. This is a retrospective study including patients from the Houston Methodist Young ACS-PCI registry. The cohort incorporates patients ≤50 years old experiencing type 1 MI and undergoing PCI between 2010 and 2022. The primary endpoint was 1-year major adverse cardiovascular events (MACE) (all-cause mortality, MI, and ischemic stroke). Secondary endpoints included components of MACE and repeat revascularization. Of 628 young adults undergoing PCI for ACS (median age 45 years, 23.6% women), 10.4% were on dialysis. Patients receiving dialysis were more often women (49.2% vs 20.6%, p < 0.001), Black (32.3% vs 16.5%, p = 0.009), and had more frequent cardiovascular risk factors. There was no difference in terms of ACS presentation. Angiographic characteristics were similar, but femoral access was more common in the dialysis group (98.5% vs 83.7%, p = 0.006). Patients on dialysis had longer hospital stays (4 vs 2 days; p < 0.001), major bleeding (10.8% vs 2.3%; p = 0.001) and higher 1-year MACE (26.2% vs 9.8%; p < 0.001), 1-year all-cause mortality (13.9% vs 3.4%; p < 0.001), and recurrent MI (13.9% vs 6.4%, p = 0.02). The risk of MACE (HR 2.7, 95% CI: 1.5-4.7) and long-term mortality (HR 4.9, 95% CI: 2.6-9.0) were higher among patients receiving dialysis. In conclusion, young adults on dialysis who undergo PCI for ACS face significantly higher comorbidity burden, bleeding risk, and long-term adverse outcomes, including increased MACE and mortality. Careful consideration is essential in this high-risk group and preventive measures should be undertaken to improve outcomes in this high-risk population.