Characteristics, trends and outcomes in acute coronary syndromes in the renal replacement therapy population: a 10-year retrospective analysis of the Midlands Region, New Zealand.

Acute coronary syndrome (ACS) is one of the leading causes of mortality in the renal replacement therapy (RRT) population. We aimed to understand the characteristics, trends and outcomes of ACS in our local RRT population as a means to improve care and outcomes for this high-risk population. Using the ANZACS-QI database, we conducted a retrospective analysis of all ACS occurring in RRT patients between 1 January 2010-31 December 2019 managed at Waikato Hospital (n=135 at index ACS). In our cohort made up predominantly of Maori (55%) and European (34%) patients, 58% had diabetic nephropathy as their primary disease. Twenty-seven percent presented atypically and 65% had a delay of >72 hours from diagnosis to angiogram. There was a 49% mortality rate at one year post-index ACS. Factors associated with mortality at one year included: atypical presentation (chi-square statistic (X2) 7.250; p=0.0071), troponin delta >20% (X2 5.682; p=0.0171), peak troponin (point biserial correlation; r=0.2086; p=0.0473) and no revascularisation (X2 5.2419; p=0.0221). The findings in our cohort reiterate that patients on RRT are a vulnerable population who have poor outcomes associated with ACS, driven by multifactorial delays in diagnosis and treatment.