Temporal management patterns and outcomes of non-ST elevation acute coronary syndromes in patients with kidney dysfunction

Abstract

Despite temporal increases in invasive management of NSTE-ACS, patients with kidney dysfunction are more commonly treated conservatively, with an associated worse outcome. In-hospital revascularization was independently associated with improved survival, irrespective of eGFR. Randomized controlled trials involving patients with kidney dysfunction are needed to confirm whether more aggressive treatment will improve their poor outcome.

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)

“…Our analysis found that MI patients differ in their clinical and angiographic characteristics, depending on their IRF grade, consistent with the findings of other studies [5][6][7][8][12][13][14][15][16]. In patients with worse IRF, there is a greater percentage of predictors of poorer prognosis.…”

“…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. The observed differences between the studies result from the adopted definitions of renal dysfunction and criteria use to select and stratify the analysed population.…”

“…In our analysis, we noted less frequent use of acetylsalicylic acid, clopidogrel, and unfractionated heparin, and more frequent use of low-molecular weight heparin, in the groups with greater IRF. This suggests some apprehension among physicians concerning the use of anticoagulant and antiplatelet medications in patients with IRF, as has been observed elsewhere [5,8]. With regard to antiplatelet agents, a sub-analysis of the PLATO study performed in patients with eGFR < 60 mL/min/1.73 m 2 showed that ticagrelor was superior to clopidogrel in reducing a composite endpoint (17.3 vs. 22.0%; HR 0.77; 95% CI 0.65-0.90), including mortality (10.0 vs. 14.0%; HR 0.72; 95% CI 0.58-0.89) over 12-month follow-up, without significantly increasing the risk of major bleeding, bleeding resulting in death, and bleeding not related to coronary artery bypass grafting [17].…”

“…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.…”

Renal Dysfunction in Patients With Acute Coronary Syndrome (Acs) at a Tertiary Care Hospital

“…21 The pathophysiology in ACS patients with underlying renal dysfunction has been studied 22 Lesions in the coronaries of patients with renal dysfunction were found to be longer with more luminal encroachment and have higher plaque burden compared to coronaries of non renal dysfunction patients. Coronary plaque composition assessed with radio frequency IVUS depicted greater necrotic core with dense calcium and less fibrous tissue, all these changes make the coronary plaque less stable.…”