Effects of renal insufficiency on early invasive management in patients with acute coronary syndromes (The TACTICS-TIMI 18 Trial)

Arora

et al. 2018

JAHA

BackgroundChronic kidney disease (CKD) remains an independent predictor of cardiovascular morbidity and mortality. CKD complicates referral for percutaneous coronary intervention (PCI) in non–ST‐segment–elevation myocardial infarction (NSTEMI) patients because of the risk for acute kidney injury and the need for dialysis, with American College of Cardiology/American Heart Association guidelines underscoring the limited data on these patients.Methods and ResultsUsing the National Inpatient Sample to analyze hospitalizations in the United States from 2004 to 2014, we sought to assess PCI utilization and in‐hospital outcomes in NSTEMI admissions with CKD. NSTEMI admissions were identified by International Classification of Diseases, Ninth Edition, Clinical Modification (ICD‐9‐CM) code 410.7. CKD admissions were identified by ICD‐9‐CM code 585. Propensity score–matched cohorts of patients with NSTEMI were matched for age, sex, comorbidities, race, median household income, primary payer status, and hospital characteristics. Of 4 488 795 hospitalizations for NSTEMI, 31% underwent PCI. Overall, 89% of admissions had no CKD. In addition, 32% of NSTEMI admissions with no CKD and 23%, 14%, and 22% with CKD stages 3, 4, and 5 underwent PCI, respectively. Hospitalized NSTEMI patients with CKD stages 4 and 5 had 41% and 20% less likelihood, respectively, of undergoing PCI compared with those with no CKD. Among hospitalized NSTEMI patients with no CKD or CKD stage 3, 4, or 5, PCI‐treated groups had 63%, 57%, 39%, and 59% lower likelihood, respectively, of all‐cause, in‐hospital mortality compared with propensity score–matched medically managed groups.Conclusions PCI use decreased among hospitalized NSTEMI patients as CKD severity increased, and all‐cause, in‐hospital mortality was greater for NSTEMI patients admitted with more severe CKD regardless of treatment strategy.

Section: Discussionmentioning

confidence: 99%

Non–ST‐Segment–Elevation Myocardial Infarction Among Patients With Chronic Kidney Disease: A Propensity Score–Matched Comparison of Percutaneous Coronary Intervention Versus Conservative Management

Arora

et al. 2018

JAHA

“…In the randomised clinical trials that have included patients with MI and renal dysfunction, the percentage of patients with moderate or higher grade of IRF (eGFR < 60 mL/min/1.73 m 2 ) ranged from 13.8% to 45.7% [12][13][14][15][16][17][18], while in registries from the past five years it ranged from 28.9% to 42.9% [5][6][7][8]. The populations of patients with particular IRF grades noted in our analysis are comparable with the data from the GRACE [5], ACS I/II [5], and SWEDEHEART [7] registries.…”

Section: Discussionmentioning

confidence: 99%

Renal function on admission affects both treatment strategy and long-term outcomes of patients with myocardial infarction (from the Polish Registry of Acute Coronary Syndromes)

et al. 2017

“…21,26 Dose adjustment of LWMH for patients older than 75 years of age is therefore recommended. [26][27][28] Dutch physicians do not routinely adjust anticoagulation dosing for these patients. A possible explanation is that age is assessed in a broader clinical perspective instead of as an independent risk factor.…”

Section: Renal Failurementioning

confidence: 99%

Guideline adherence for antithrombotic therapy in acute coronary syndrome: an overview in Dutch hospitals

Kikkert

Piek²,

Winter³

et al. 2010

NHJL

Objective. To assess current Dutch antithrombotic treatment strategies for acute coronary syndrome (ACS) in light of the current European Society of Cardiology (ESC) guidelines. Methods. For every Dutch hospital with a coronary care unit (CCU) (n = 93) a single cardiologist was interviewed concerning heparin, thienopyridine and GP IIb/IIIa inhibitor (GPI) treatment. In each hospital, we randomly approached one cardiologist assuming equal policy among physicians employed at the same hospital.