Key result
Percutaneous coronary intervention was associated with a lower risk of death compared to no PCI in elderly NSTEMI patients across all eGFR groups.
Why the study?
Data were lacking regarding the benefit of revascularization by PCI during NSTEMI in patients aged >80 years with concurrent chronic kidney disease.
Does percutaneous coronary intervention reduce all-cause mortality in elderly patients (>80 years) with NSTEMI and chronic kidney disease?
Cohort (n=12,821)
Yes
Does percutaneous coronary intervention reduce all-cause mortality in elderly patients (>80 years) with NSTEMI and chronic kidney disease?
In patients over 80 years old with NSTEMI and chronic kidney disease, PCI is associated with a significant survival benefit despite a higher risk of bleeding in those with severe renal impairment.
Answers are grounded in this paper and cite their sources.
PCI associated with lower mortality across eGFR strata in elderly NSTEMI; leaves open whether revascularization improves outcomes in this population.
Background There is a paucity of data on the benefit of revascularization by percutaneous coronary intervention ( PCI ) during non–ST‐segment–elevation myocardial infarction in patients aged >80 years with concurrent chronic kidney disease. Methods and Results Patients aged >80 years with chronic kidney disease, defined as an estimated glomerular filtration rate ( eGFR ) <60 mL/min per 1.73 m 2 with non–ST‐segment–elevation myocardial infarction, during 2011 to 2014 in Sweden retrieved from the SWEDEHEART (Swedish Web‐System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies) Registry. Cox regression was used to estimate adjusted hazard ratios with 95% CIs for all‐cause mortality in patients with PCI versus no PCI treatment, stratified for eGFR . Logistic regression was used to evaluate adjusted odds for reinfarction and bleeding during hospitalization. Propensity score weighting analysis was also done as sensitivity analysis. In total, 12 821 patients were included, of whom 47%, 45%, and 8% had an eGFR of >60, 30 to 60, and 15 to <30 mL/min per 1.73 m 2 , respectively. Patients with eGFR 30 to 60 and 15 to <30 mL/min per 1.73 m 2 , 22%, and 10%, respectively, underwent PCI , compared with 36% among patients with eGFR >60 mL/min per 1.73 m 2 . During a mean follow‐up of 3.2 years, the absolute risk of death was 42%, 56%, and 76% in patients with eGFR >60, 30 to 60, and 15 to <30 mL/min per 1.73 m 2 , respectively. Patients who underwent PCI had a lower risk of death in all groups of eGFR (0.47 [95% CI, 0.42–0.53], 0.50 [95% CI, 0.45–0.56], and 0.44 [95% CI, 0.33–0.59], respectively). Patients with eGFR 15 to <30 mL/min per 1.73 m 2 had a higher risk of bleeding with PCI . Propensity score weighting showed similar outcomes for mortality risk as the unweighted analysis in all the eGFR groups. Conclusions PCI is rarely used in non–ST‐segment–elevation myocardial infarction elderly patients with chronic kidney disease, and it appears to offer a survival benefit.
No takes yet. Share an insight, caveat, or question.
Holzmann et al. (2020) conducted a cohort in Non-ST-segment-elevation myocardial infarction with chronic kidney disease (n=12,821). Percutaneous coronary intervention (PCI) vs. No PCI treatment was evaluated on All-cause mortality (HR 0.44-0.50). Percutaneous coronary intervention was associated with a lower risk of death compared to no PCI in elderly NSTEMI patients across all eGFR groups.
Synapse has enriched 10 related papers. Consider them for comparative context: