Journal article
Characteristics and In-Hospital Outcomes of Patients With Non-ST-Segment Elevation Myocardial Infarction and Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention
JACC. Cardiovascular interventions, Vol.4(9), pp.1002-1008
09/01/2011
DOI: 10.1016/j.jcin.2011.05.022
PMCID: PMC4769863
PMID: 21939940
Abstract
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 15, 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. (J Am Coll Cardiol Intv 2011;4:1002-8) 2011 (C) by the American College of Cardiology Foundation
Details
- Title: Subtitle
- Characteristics and In-Hospital Outcomes of Patients With Non-ST-Segment Elevation Myocardial Infarction and Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention
- Creators
- Elias B. Hanna - Louisiana State UniversityAnita Y. Chen - Duke UniversityMatthew T. Roe - Duke UniversityStephen D. Wiviott - Thrombolysis in Myocardial Infarction Study GroupCaroline S. Fox - Brigham and Women's HospitalJorge F. Saucedo - University of Oklahoma Health Sciences Center
- Resource Type
- Journal article
- Publication Details
- JACC. Cardiovascular interventions, Vol.4(9), pp.1002-1008
- DOI
- 10.1016/j.jcin.2011.05.022
- PMID
- 21939940
- PMCID
- PMC4769863
- NLM abbreviation
- JACC Cardiovasc Interv
- ISSN
- 1936-8798
- eISSN
- 1876-7605
- Publisher
- Elsevier
- Number of pages
- 7
- Grant note
- AstraZeneca Bristol-Myers Squibb American College of Cardiology; General Electric Merck; Merck & Company Holsinn Pharmaceuticals Schering-Plough; Merck & Company; Schering Plough Corporation Pfizer Inc.; Pfizer Medtronic American Heart Association Boston Scientific Regeneron Eli Lilly Orexigen Daiichi Sankyo; Daiichi Sankyo Company Limited KAI Pharmaceuticals Sanofi Aventis; Sanofi-Aventis Abbott; Abbott Laboratories ZIAHL006094 / NATIONAL HEART, LUNG, AND BLOOD INSTITUTE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI) Roche; Roche Holding
- Language
- English
- Date published
- 09/01/2011
- Academic Unit
- Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984359577302771
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