Key result
Severe kidney impairment in NSTEMI linked to ~42% lower likelihood of invasive management vs normal function.
Why the study?
Substantial variation and potential disparities in AMI treatment across English hospitals were hypothesised, particularly for patients hospitalised for NSTEMI and with reduced kidney function.
Does reduced kidney function reduce the likelihood of receiving invasive cardiac intervention in patients hospitalized for acute myocardial infarction?
Cross-Sectional (n=361,259)
Yes
Does reduced kidney function reduce the likelihood of receiving invasive cardiac intervention in patients hospitalized for acute myocardial infarction?
Absolute Event Rate: 44.5% vs 76.6%
There is substantial variation in AMI management across English hospitals, with patients having reduced kidney function, particularly those with NSTEMI, being significantly less likely to receive invasive cardiac interventions.
May signal care disparities in NSTEMI with severe kidney impairment; leaves open appropriateness, mechanisms, and outcome effects.
OBJECTIVES: We hypothesised that there is substantial variation in acute myocardial infarction (AMI) treatment across English hospitals, particularly for people hospitalised for non-ST-elevation myocardial infarction (NSTEMI) and with reduced kidney function. This study aimed to describe this variation at the hospital and the individual level to understand treatment variation and potential disparities in AMI management among people with reduced kidney function. DESIGN: Cross-sectional study. SETTING: Secondary care in England. PARTICIPANTS: People hospitalised for AMI (ST-elevation myocardial infarction (STEMI) or NSTEMI) in English hospitals and captured in the Myocardial Ischaemia National Audit Project, 2014 to 2019. Kidney function was defined using estimated glomerular filtration rate (eGFR) derived from the serum creatinine recorded within 24 hours of AMI admission. OUTCOME MEASURE: The primary outcome was recorded invasive cardiac intervention (at least one of angiography, percutaneous coronary intervention and coronary artery bypass graft) compared with conservative management. RESULTS: We included 361 259 people with a first hospitalisation for AMI (STEMI or NSTEMI) at 209 hospitals for hospital-level analyses and 292 572 people with complete covariable data at 207 hospitals for individual-level analyses. We found substantial variation in the mean proportion of people with NSTEMI managed invasively across hospitals in England. At the individual level, using multivariable logistic regression to derive adjusted predicted probabilities to describe the association between kidney function and AMI management (invasive vs conservative management), we found that people had a lower adjusted predicted probability of being treated with invasive cardiac management with worsening eGFR range, particularly for NSTEMI cases (eGFR range 2: 76.6% (95% CI 76.3 to 76.8) vs eGFR range 5: 44.5% (95% CI 41.2 to 47.5)). CONCLUSIONS: There is substantial AMI treatment variation across hospitals in England, particularly among people hospitalised for NSTEMI with reduced kidney function. Further research is needed to evaluate the comparative effectiveness of NSTEMI management strategies for complex patients.
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Bidulka et al. (2025) conducted a cross-sectional in Acute myocardial infarction (STEMI or NSTEMI) (n=361,259). Reduced kidney function (eGFR range 5) vs. Normal kidney function (eGFR range 2) was evaluated on Invasive cardiac management (angiography, PCI, or CABG). Patients hospitalized for NSTEMI with severe kidney impairment (eGFR range 5) had a lower adjusted predicted probability of receiving invasive cardiac management compared to those with normal kidney function (44.5% vs 76.6%).
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