BACKGROUND AND OBJECTIVES: In the general population, an early invasive strategy of routine coronary angiography is superior to a conservative strategy of selective angiography in patients who are admitted with unstable angina or non-ST segment elevation myocardial infarction (MI), but the effectiveness of this strategy in individuals with chronic kidney disease (CKD) is uncertain. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a collaborative meta-analysis with data provided by the main authors of identified trials to estimate the effectiveness of early angiography in patients with CKD. The Cochrane, Medline, and EMBASE databases were searched to identify randomized trials that compared invasive and conservative strategies in patients with unstable angina or non-ST MI. Pooled risks ratios were estimated using data from enrolled patients with estimated GFR <60 ml/min per 1.73 m(2). RESULTS: Five randomized trials that enrolled 1453 patients with CKD were included. An early invasive strategy was associated with nonsignificant reductions in all-cause mortality, nonfatal MI, and a composite of death or nonfatal MI. The invasive strategy significantly reduced rehospitalization. CONCLUSIONS: This collaborative study suggests that the benefits of an early invasive strategy are preserved in patients with CKD and that an early invasive approach reduces the risk for rehospitalization and is associated with trends of reduction in the risk for death and nonfatal re-infarction in patients with CKD. Coronary angiography should be considered for patients who have CKD and are admitted with non-ST elevation acute coronary syndromes.
BACKGROUND AND OBJECTIVES: In the general population, an early invasive strategy of routine coronary angiography is superior to a conservative strategy of selective angiography in patients who are admitted with unstable angina or non-ST segment elevation myocardial infarction (MI), but the effectiveness of this strategy in individuals with chronic kidney disease (CKD) is uncertain. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a collaborative meta-analysis with data provided by the main authors of identified trials to estimate the effectiveness of early angiography in patients with CKD. The Cochrane, Medline, and EMBASE databases were searched to identify randomized trials that compared invasive and conservative strategies in patients with unstable angina or non-ST MI. Pooled risks ratios were estimated using data from enrolled patients with estimated GFR <60 ml/min per 1.73 m(2). RESULTS: Five randomized trials that enrolled 1453 patients with CKD were included. An early invasive strategy was associated with nonsignificant reductions in all-cause mortality, nonfatal MI, and a composite of death or nonfatal MI. The invasive strategy significantly reduced rehospitalization. CONCLUSIONS: This collaborative study suggests that the benefits of an early invasive strategy are preserved in patients with CKD and that an early invasive approach reduces the risk for rehospitalization and is associated with trends of reduction in the risk for death and nonfatal re-infarction in patients with CKD. Coronary angiography should be considered for patients who have CKD and are admitted with non-ST elevation acute coronary syndromes.
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Authors: Charanjit S Rihal; Stephen C Textor; Diane E Grill; Peter B Berger; Henry H Ting; Patricia J Best; Mandeep Singh; Malcolm R Bell; Gregory W Barsness; Verghese Mathew; Kirk N Garratt; David R Holmes Journal: Circulation Date: 2002-05-14 Impact factor: 29.690
Authors: L A Szczech; P J Best; E Crowley; M M Brooks; P B Berger; V Bittner; B J Gersh; R Jones; R M Califf; H H Ting; P J Whitlow; K M Detre; D Holmes Journal: Circulation Date: 2002-05-14 Impact factor: 29.690
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Authors: Jeffrey L Anderson; Cynthia D Adams; Elliott M Antman; Charles R Bridges; Robert M Califf; Donald E Casey; William E Chavey; Francis M Fesmire; Judith S Hochman; Thomas N Levin; A Michael Lincoff; Eric D Peterson; Pierre Theroux; Nanette Kass Wenger; R Scott Wright; Sidney C Smith; Alice K Jacobs; Cynthia D Adams; Jeffrey L Anderson; Elliott M Antman; Jonathan L Halperin; Sharon A Hunt; Harlan M Krumholz; Frederick G Kushner; Bruce W Lytle; Rick Nishimura; Joseph P Ornato; Richard L Page; Barbara Riegel Journal: J Am Coll Cardiol Date: 2007-08-14 Impact factor: 24.094
Authors: Jassim Al Suwaidi; Donal N Reddan; Kathryn Williams; Karen S Pieper; Robert A Harrington; Robert M Califf; Christopher B Granger; E Magnus Ohman; David R Holmes Journal: Circulation Date: 2002-08-20 Impact factor: 29.690
Authors: Ramin S Hastings; Judith S Hochman; Vladimir Dzavik; Gervasio A Lamas; Sandra A Forman; Francois Schiele; Lampros K Michalis; Dimitris Nikas; Joanna Jaroch; Harmony R Reynolds Journal: Am J Cardiol Date: 2012-06-22 Impact factor: 2.778
Authors: Venkatesh L Murthy; Masanao Naya; Courtney R Foster; Jon Hainer; Mariya Gaber; Sharmila Dorbala; David M Charytan; Ron Blankstein; Marcelo F Di Carli Journal: JACC Cardiovasc Imaging Date: 2012-10
Authors: Venkatesh L Murthy; Timothy M Bateman; Rob S Beanlands; Daniel S Berman; Salvador Borges-Neto; Panithaya Chareonthaitawee; Manuel D Cerqueira; Robert A deKemp; E Gordon DePuey; Vasken Dilsizian; Sharmila Dorbala; Edward P Ficaro; Ernest V Garcia; Henry Gewirtz; Gary V Heller; Howard C Lewin; Saurabh Malhotra; April Mann; Terrence D Ruddy; Thomas H Schindler; Ronald G Schwartz; Piotr J Slomka; Prem Soman; Marcelo F Di Carli; Andrew Einstein; Raymond Russell; James R Corbett Journal: J Nucl Cardiol Date: 2018-02 Impact factor: 5.952
Authors: Juli Finlay; Todd Wilson; Pantea Amin Javaheri; Winnie Pearson; Carol Connolly; Meghan J Elliott; Michelle M Graham; Colleen M Norris; Stephen B Wilton; Matthew T James Journal: CMAJ Open Date: 2020-12-10