Abstract
Percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) undergoing hemodialysis (HD) remains challenging, with limited long-term outcome data. We investigated the long-term prognosis of ACS due to de novo coronary artery lesions and stent thrombosis (ST) in patients with and without HD. We analyzed 187 patients with ACS from the Osaka Cardiovascular Conference Long ST registry, a retrospective, multicenter registry of definite ST, and 1,856 patients with ACS due to de novo coronary artery lesions at Kansai Rosai Hospital. Patients were grouped by HD status and ACS etiology (de novo- and ST-ACS). The primary outcome was the 6-year incidence of major adverse cardiac events (MACE) defined as a composite of cardiac death, non-fatal myocardial infarction, target vessel revascularization, and subsequent ST. The 6-year MACE rate was highest in ST-ACS with HD, followed by de novo-ACS with HD, ST-ACS without HD, and de novo-ACS without HD (82.1 vs. 62.5 vs. 38.3 vs. 24.2%, respectively, p < 0.001). Multivariate analysis identified HD (hazard ratio [HR]: 2.50, 95% confidence interval [CI]: 1.89-3.32, p < 0.001) and ST-ACS (HR: 1.69, 95% CI: 1.17-2.45, p = 0.006) as independent MACE predictors. The long-term prognoses following ACS are unfavorable in patients on HD, particularly those with ST-ACS.