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.
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.
Authors: Tammy M Keough-Ryan; Bryce A Kiberd; Christine S Dipchand; Jafna L Cox; Caren L Rose; Kara J Thompson; Catherine M Clase Journal: Am J Kidney Dis Date: 2005-11 Impact factor: 8.860
Authors: George Dangas; Ioannis Iakovou; Eugenia Nikolsky; Eve D Aymong; Gary S Mintz; Nicholas N Kipshidze; Alexandra J Lansky; Issam Moussa; Gregg W Stone; Jeffrey W Moses; Martin B Leon; Roxana Mehran Journal: Am J Cardiol Date: 2005-01-01 Impact factor: 2.778
Authors: C P Cannon; W S Weintraub; L A Demopoulos; R Vicari; M J Frey; N Lakkis; F J Neumann; D H Robertson; P T DeLucca; P M DiBattiste; C M Gibson; E Braunwald Journal: N Engl J Med Date: 2001-06-21 Impact factor: 91.245
Authors: Luis Gruberg; George Dangas; Roxana Mehran; Gary S Mintz; Kenneth M Kent; Augusto D Pichard; Lowell F Satler; Alexandra J Lansky; Gregg W Stone; Martin B Leon Journal: Catheter Cardiovasc Interv Date: 2002-01 Impact factor: 2.692
Authors: Bo Lagerqvist; Steen Husted; Fredrik Kontny; Elisabeth Ståhle; Eva Swahn; Lars Wallentin Journal: Lancet Date: 2006-09-16 Impact factor: 79.321
Authors: Chee Tang Chin; Anita Y Chen; Tracy Y Wang; Karen P Alexander; Robin Mathews; John S Rumsfeld; Christopher P Cannon; Gregg C Fonarow; Eric D Peterson; Matthew T Roe Journal: Am Heart J Date: 2011-01 Impact factor: 4.749
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: Karen P Alexander; Anita Y Chen; Matthew T Roe; L Kristin Newby; C Michael Gibson; Nancy M Allen-LaPointe; Charles Pollack; W Brian Gibler; E Magnus Ohman; Eric D Peterson Journal: JAMA Date: 2005-12-28 Impact factor: 56.272
Authors: Jin H Han; Abhinav Chandra; Jyotsna Mulgund; Matthew T Roe; Eric D Peterson; Lynda A Szczech; Uptal Patel; E Magnus Ohman; Christopher J Lindsell; W Brian Gibler Journal: Am J Med Date: 2006-03 Impact factor: 4.965