Timing of Coronary Angiography and Outcome in Patients with Non-ST Elevation Acute Coronary Syndromes and Kidney Disease: Real-World Data from the Acute Coronary Syndromes Israeli Survey

OBJECTIVE: Patients with kidney disease (KD) who present with non-ST segment elevation acute coronary syndromes (NSTE-ACS) may benefit from coronary intervention. We evaluated the outcome of these patients who were referred for early or late coronary angiography. METHODS: The risk of 1-year mortality according to the presence of KD [estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2)] and the time of coronary angiography [categorized as early (≤48 h from admission) or late (>48 h from admission)] was assessed among 2,001 NSTE-ACS patients enrolled in the ACS Israeli Survey between 2004 and 2008. A propensity score for early angiography was included in the proportional hazards modeling of mortality. RESULTS: Patients with KD (n = 729) experienced a 2.7-fold increased risk of death compared with non-KD patients (p < 0.001). Early coronary angiography was associated with a lower rate of in-hospital complications and 30-day mortality. Both early and late angiography were associated with a lower adjusted risk of 1-year mortality [hazard ratios (HRs) 0.46 (p < 0.001) and 0.59 (p = 0.002), respectively] compared with no angiography. In patients with severe KD (eGFR <30 ml/min/1.73 m(2)), only early coronary angiography was associated with a lower mortality risk (HR 0.25, 95% confidence interval 0.08-0.81). CONCLUSIONS: An early invasive strategy is associated with a low mortality risk in NSTE-ACS patients with KD and a more pronounced effect among those with severe KD.