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compared it to other patients with STEMI which they categorized as the general population. There were 882,447 STEMI hospitalizations, 11,383 were in ESRD patients on maintenance dialysis and 1,076 were in renal transplant patients. They found that incidences of STEMI in dialysis patients and renal transplant recipients were 7.7 and 1.3 times, respectively, higher than in the general population. The incidence declined over the study period, although it did not reach statistical significance in the renal transplant patients; the decline was greatest in the maintenance dialysis patients compared to the general population. The utilization of revascularization procedures was lowest in patients on maintenance dialysis compared to the other 2 categories. The in-hospital mortality was highest in patients on dialysis; being on dialysis and having renal transplant were independent predictors of in-hospital mortality. Data on the incidence, management and outcomes of STEMI in patients with ESRD on dialysis and renal transplant patients are limited. The incidence and severity of coronary artery disease increase as the glomerular filtration rates decline. Coronary disease in patients with impaired kidney function and ESRD usually has a pattern of multi-vessel involvement with coronary calcification. Although the incidence of AMI is known to be elevated in patients with ESRD, Sakhuja et al. [5] has now demonstrated that the incidence of STEMI per se is also elevated in patients with ESRD on dialysis. This is not surprising since patients with ESRD have high incidence of comorCardiovascular death is the leading cause of mortality in patients with end-stage renal disease (ESRD). It is also the leading cause of death in renal transplant patients [1] . Over the past few decades, multiple studies showed that the incidence of acute myocardial infarction (AMI) is high in patients with ESRD and that the incidence of AMI is directly related to the reduction in kidney function, with increased mortality in this patient population [2] . It has also been shown that the utilization of urgent coronary revascularization in the form of either primary percutaneous coronary intervention or coronary artery bypass graft surgery, to preserve myocardial tissue, is unfortunately low in this high risk patient population compared to the general population [2] . AMI is a broad term which includes 5 different types as outlined in the Universal Definition of Myocardial Infarction expert writing group consensus document [3] . Electrocardiographically, AMI shows on the tracing as either ST-segment elevation (STEMI) or ST-segment depression or no ST-segment change. Acute and complete blockage of a coronary artery or its branch usually reflects on the electrocardiogram as STEMI. There has been paucity of studies looking into STEMI in patients with ESRD on dialysis and in renal transplant patients [4] . In this issue, Sakhuja et al. [5] used the National Inpatient Sample Database and investigated the incidence of STEMI in patients with ESRD on maintenance dialysis and in renal transplant patients during a 5-year period, and Published online: October 6, 2016 Nephrology American Journal of

ST-Segment Elevation Myocardial Infarction in Dialysis and Renal Transplant Patients. How Does It Compare to That in the General Population?