Key result
Patients with non-end-stage CKD and those requiring RRT received significantly less standard guideline-based invasive and pharmacological MI treatment compared with patients with no renal disease.
Why the study?
Does the presence of chronic kidney disease affect the receipt of standard guideline-based invasive and pharmacological treatment for myocardial infarction?
Cohort (n=83,454)
Yes
Does the presence of chronic kidney disease affect the receipt of standard guideline-based invasive and pharmacological treatment for myocardial infarction?
Despite improvements in care over time, patients with chronic kidney disease remain significantly undertreated with standard guideline-based invasive and pharmacological therapies following myocardial infarction compared to patients with normal renal function.
CKD-MI patients remain undertreated; leaves open whether targeted interventions can improve guideline adherence and outcomes.
AIMS: The aim of this Danish nationwide study was to evaluate the treatment of myocardial infarction (MI) in patients with non-end-stage chronic kidney disease (CKD) and in patients requiring renal replacement therapy (RRT). Upgraded guidelines for the management of MI were implemented around 2004; hence, the treatment of MI in the time periods before and after 2004 was compared in order to evaluate the impact for patients with CKD. METHODS AND RESULTS: By linking nationwide registries by the personal registration number, we identified patients admitted to Danish hospitals with first time MI in the period 2000-09 (79 585 with no renal disease, 3144 with non-end-stage CKD, and 725 requiring RRT). Cox proportional hazards model was used to estimate the chance of invasive treatment within 60 days after MI and the chance of filling prescriptions on recommended post-MI drugs within 90 days before and after 2004. Significantly less use of relevant MI treatment in patients with non-end-stage CKD and patients requiring RRT compared with patients with no renal disease were seen; however, the absolute frequencies of invasive procedures and filled prescriptions on post-MI drugs increased after 2004 in all patients. CONCLUSIONS: After 2004, invasive and pharmacological treatment of first-time MI improved in patients with non-end-stage CKD and patients requiring RRT; however, all CKD patients were less treated with standard MI care compared with patients with no renal disease.
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Blicher et al. (2013) conducted a cohort in First-time myocardial infarction (n=83,454). Chronic kidney disease (non-end-stage or requiring renal replacement therapy) vs. No renal disease was evaluated on Invasive treatment within 60 days after MI and filling prescriptions on recommended post-MI drugs within 90 days. Patients with non-end-stage CKD and those requiring RRT received significantly less standard guideline-based invasive and pharmacological MI treatment compared with patients with no renal disease.
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