BACKGROUND: The characteristics, therapies, and outcomes of patients presenting with non-ST-segment elevation myocardial infarction, found to have significant coronary artery disease on coronary angiography, and managed without revascularization ("nonrevascularized patients") have not been evaluated previously in a large-scale registry. METHODS: We examined data on 13,872 non-ST-segment elevation myocardial infarction nonrevascularized patients who were captured by the Acute Coronary Treatment and Intervention Outcomes Network registry. Patients were divided according to baseline renal function in 4 groups: no chronic kidney disease (CKD) and CKD stages 3, 4, and 5. RESULTS: The in-hospital mortality of nonrevascularized patients was 3.7%, whereas their in-hospital major bleeding rate was 10.8%. Overall, 44.2% (n = 6,132) of nonrevascularized patients had CKD. Compared with patients with normal renal function, nonrevascularized patients with CKD had significantly more history of myocardial infarction, heart failure, more 3-vessel coronary artery disease, and received fewer antithrombotic therapies. 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. The multivariable-adjusted odds ratios of in-hospital mortality for CKD stages 3, 4, and 5 relative to no CKD were 1.5, 2.5, and 2.2, respectively (global P < .0001), and the analogous adjusted odds ratios of major bleeding were 1.5, 2.5, and 1.8 (global P < .0001). CONCLUSION: Nonrevascularized patients have a high in-hospital mortality. Nonrevascularized patients with CKD have more comorbidities than patients without CKD and less frequently receive guideline-recommended therapies. Chronic kidney disease is strongly associated with in-hospital mortality and bleeding.
BACKGROUND: The characteristics, therapies, and outcomes of patients presenting with non-ST-segment elevation myocardial infarction, found to have significant coronary artery disease on coronary angiography, and managed without revascularization ("nonrevascularized patients") have not been evaluated previously in a large-scale registry. METHODS: We examined data on 13,872 non-ST-segment elevation myocardial infarction nonrevascularized patients who were captured by the Acute Coronary Treatment and Intervention Outcomes Network registry. Patients were divided according to baseline renal function in 4 groups: no chronic kidney disease (CKD) and CKD stages 3, 4, and 5. RESULTS: The in-hospital mortality of nonrevascularized patients was 3.7%, whereas their in-hospital major bleeding rate was 10.8%. Overall, 44.2% (n = 6,132) of nonrevascularized patients had CKD. Compared with patients with normal renal function, nonrevascularized patients with CKD had significantly more history of myocardial infarction, heart failure, more 3-vessel coronary artery disease, and received fewer antithrombotic therapies. 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. The multivariable-adjusted odds ratios of in-hospital mortality for CKD stages 3, 4, and 5 relative to no CKD were 1.5, 2.5, and 2.2, respectively (global P < .0001), and the analogous adjusted odds ratios of major bleeding were 1.5, 2.5, and 1.8 (global P < .0001). CONCLUSION: Nonrevascularized patients have a high in-hospital mortality. Nonrevascularized patients with CKD have more comorbidities than patients without CKD and less frequently receive guideline-recommended therapies. Chronic kidney disease is strongly associated with in-hospital mortality and bleeding.
Authors: Zach Rozenbaum; Sydney Benchetrit; Saar Minha; Yoram Neuman; Meital Shlezinger; Ilan Goldenberg; Morris Mosseri; David Pereg Journal: Cardiorenal Med Date: 2017-02-17 Impact factor: 2.041
Authors: Maria Udeanu; Giordano Guizzardi; Giuseppe Di Pasquale; Antonio Marchetti; Francesca Romani; Vittorio Dalmastri; Irene Capelli; Lucia Stalteri; Giuseppe Cianciolo; Paola Rucci; Gaetano La Manna Journal: BMC Nephrol Date: 2014-09-17 Impact factor: 2.388
Authors: Randi E Foraker; Avirup Guha; Henry Chang; Emily C O'Brien; Julie K Bower; Elliott D Crouser; Wayne D Rosamond; Subha V Raman Journal: Glob Heart Date: 2018-03-05
Authors: Paul R Kalra; Xavier García-Moll; José Zamorano; Philip A Kalra; Kim M Fox; Ian Ford; Roberto Ferrari; Jean-Claude Tardif; Michal Tendera; Nicola Greenlaw; Ph Gabriel Steg Journal: PLoS One Date: 2014-07-22 Impact factor: 3.240