Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr 1;5(4):e227624.
doi: 10.1001/jamanetworkopen.2022.7624.

Trends in Mortality Due to Myocardial Infarction, Stroke, and Pulmonary Embolism in Patients Receiving Dialysis

Gurbey Ocak  1 , Rianne Boenink  2 , Marlies Noordzij  2 , Willem Jan W Bos  1   3 , Bjorn E Vikse  4   5 , Aleix Cases  6   7 , Julia Kerschbaum  8 , Jaakko Helve  9   10 , Maurizio Nordio  11   12 , Mustafa Arici  13 , Lucile Mercadal  14 , Christoph Wanner  15 , Runolfur Palsson  16   17 , Kristine Hommel  18 , Johan De Meester  19 , Myrto Kostopoulou  20 , Rafael Santamaria  21   22 , Emilio Rodrigo  23 , Helena Rydell  24   25 , Samira Bell  26   27 , Ziad A Massy  28   29 , Kitty J Jager  2 , Anneke Kramer  2
Affiliations

Trends in Mortality Due to Myocardial Infarction, Stroke, and Pulmonary Embolism in Patients Receiving Dialysis

Gurbey Ocak et al. JAMA Netw Open. .

Abstract

Importance: During the past decades, improvements in the prevention and management of myocardial infarction, stroke, and pulmonary embolism have led to a decline in cardiovascular mortality in the general population. However, it is unknown whether patients receiving dialysis have also benefited from these improvements.

Objective: To assess the mortality rates for myocardial infarction, stroke, and pulmonary embolism in a large cohort of European patients receiving dialysis compared with the general population.

Design, setting, and participants: In this cohort study, adult patients who started dialysis between 1998 and 2015 from 11 European countries providing data to the European Renal Association Registry were and followed up for 3 years. Data were analyzed from September 2020 to February 2022.

Exposures: Start of dialysis.

Main outcomes and measures: The age- and sex-standardized mortality rate ratios (SMRs) with 95% CIs were calculated by dividing the mortality rates in patients receiving dialysis by the mortality rates in the general population for 3 equal periods (1998-2003, 2004-2009, and 2010-2015).

Results: In total, 220 467 patients receiving dialysis were included in the study. Their median (IQR) age was 68.2 (56.5-76.4) years, and 82 068 patients (37.2%) were female. During follow-up, 83 912 patients died, of whom 7662 (9.1%) died because of myocardial infarction, 5030 (6.0%) died because of stroke, and 435 (0.5%) died because of pulmonary embolism. Between the periods 1998 to 2003 and 2010 to 2015, the SMR of myocardial infarction decreased from 8.1 (95% CI, 7.8-8.3) to 6.8 (95% CI, 6.5-7.1), the SMR of stroke decreased from 7.3 (95% CI, 7.0-7.6) to 5.8 (95% CI, 5.5-6.2), and the SMR of pulmonary embolism decreased from 8.7 (95% CI, 7.6-10.1) to 5.5 (95% CI, 4.5-6.6).

Conclusions and relevance: In this cohort study of patients receiving dialysis, mortality rates for myocardial infarction, stroke, and pulmonary embolism decreased more over time than in the general population.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Bos reported receiving grants from Zilveren Kruis Insurance outside the submitted work. Dr Arici reported receiving personal fees from Amgen, Astellas, Astra Zeneca, Bayer, Baxter, Boehringer Ingelheim, Menarini, Merck Sharp and Dohme, Novo Nordisk, Sandoz, and Sanofi outside the submitted work. Dr Wanner reported receiving grants from and being the president of the European Renal Association during the conduct of the study. Dr Santamaria reported receiving personal fees from AstraZeneca, Vifor Fresenius Medical Care Renal Pharma, and Boehringuer Ingelheim outside the submitted work. Dr Bell reported receiving personal fees from Astra Zeneca outside the submitted work. Dr Jager reported receiving grants from the European Renal Association during the conduct of the study and receiving personal fees from Fresenius Medical Care outside the submitted work. No other disclosures were reported.

References

    1. Mehta SR, Yusuf S, Peters RJ, et al. ; Clopidogrel in Unstable angina to prevent Recurrent Events trial (CURE) Investigators . Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet. 2001;358(9281):527-533. doi:10.1016/S0140-6736(01)05701-4 - DOI - PubMed
    1. Wiviott SD, Braunwald E, McCabe CH, et al. ; TRITON-TIMI 38 Investigators . Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357(20):2001-2015. doi:10.1056/NEJMoa0706482 - DOI - PubMed
    1. Wallentin L, Becker RC, Budaj A, et al. ; PLATO Investigators . Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361(11):1045-1057. doi:10.1056/NEJMoa0904327 - DOI - PubMed
    1. Packer M, Fowler MB, Roecker EB, et al. ; Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) Study Group . Effect of carvedilol on the morbidity of patients with severe chronic heart failure: results of the carvedilol prospective randomized cumulative survival (COPERNICUS) study. Circulation. 2002;106(17):2194-2199. doi:10.1161/01.CIR.0000035653.72855.BF - DOI - PubMed
    1. Pfeffer MA, Braunwald E, Moyé LA, et al. ; The SAVE Investigators . Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. N Engl J Med. 1992;327(10):669-677. doi:10.1056/NEJM199209033271001 - DOI - PubMed

Publication types