Characteristics and in-hospital outcomes of patients with non-ST-segment elevation myocardial infarction and chronic kidney disease undergoing percutaneous coronary intervention. JACC Cardiovasc Interv 2011 Sep;4(9):1002-8
Date
09/24/2011Pubmed ID
21939940Pubmed Central ID
PMC4769863DOI
10.1016/j.jcin.2011.05.022Scopus ID
2-s2.0-80052991194 (requires institutional sign-in at Scopus site) 83 CitationsAbstract
OBJECTIVES: This study sought to evaluate the characteristics, therapies, and outcomes of patients with chronic kidney disease (CKD) presenting with non-ST-segment elevation myocardial infarction (NSTEMI) and managed with percutaneous coronary intervention (PCI). This specific population has not been evaluated previously.
BACKGROUND: Among patients with acute coronary syndrome, the presence of renal dysfunction is associated with an increased risk of death and major bleeding.
METHODS: We examined data on 40,074 NSTEMI patients managed with PCI who were captured by the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) registry. Patients were divided according to baseline renal function in 4 groups: no CKD and CKD stages 3, 4, and 5.
RESULTS: Overall, 31.1% (n = 12,045) of patients with NSTEMI undergoing PCI had CKD. Compared with patients with normal renal function, CKD patients managed with PCI had significantly more history of myocardial infarction, heart failure, and more 3-vessel coronary artery disease. They received fewer antithrombotic therapies but were treated more frequently with bivalirudin. In addition, they had significantly higher rates of in-hospital mortality and major bleeding. CKD stage 4 was associated with the highest risk of adverse events relative to no CKD. The multivariable adjusted odds ratios of in-hospital mortality for CKD stages 3, 4, and 5 relative to no CKD were 2.0, 2.8, and 2.6, respectively (global p value <0.0001), and the analogous adjusted odds ratios of major bleeding were 1.5, 2.8, and 1.8, respectively (global p value <0.0001).
CONCLUSIONS: CKD patients presenting with NSTEMI and managed with PCI have more comorbidities and receive guideline-recommended therapies less frequently than do patients without CKD. CKD is strongly associated with in-hospital mortality and bleeding in NSTEMI patients undergoing PCI.
Author List
Hanna EB, Chen AY, Roe MT, Wiviott SD, Fox CS, Saucedo JFAuthor
Jorge Saucedo MD Chief, Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Angioplasty, Balloon, Coronary
Anticoagulants
Chi-Square Distribution
Chronic Disease
Comorbidity
Coronary Angiography
Female
Fibrinolytic Agents
Guideline Adherence
Hemorrhage
Hospital Mortality
Humans
Kidney Diseases
Logistic Models
Male
Middle Aged
Myocardial Infarction
Odds Ratio
Practice Guidelines as Topic
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
United States