Key result
In-hospital revascularization was independently associated with lower 1-year mortality in patients with non-ST elevation acute coronary syndromes (adjusted OR 0.52; 95% CI 0.36-0.77; P=0.001).
Why the study?
Does invasive management reduce 1-year mortality in patients with non-ST elevation acute coronary syndromes and kidney dysfunction?
Observational (n=11,377)
Yes
Does invasive management reduce 1-year mortality in patients with non-ST elevation acute coronary syndromes and kidney dysfunction?
In-hospital revascularization is associated with improved 1-year survival in NSTE-ACS patients, regardless of baseline kidney function, though patients with kidney dysfunction are less likely to receive it.
May encourage revascularization consideration in NSTE-ACS with kidney dysfunction; leaves open causal benefit pending randomized confirmation.
AIMS: To examine: (i) the temporal changes in the management pattern; (ii) the reasons for any treatment disparities; (iii) the relationship between invasive treatment and outcome, among acute coronary syndrome (ACS) patients with vs. without kidney dysfunction. METHODS AND RESULTS: Canadian ACS I, ACS II registries and Global Registry of Acute Coronary Events (GRACE) were prospective, multi-centre, observational studies of patients with ACS. From 1999 to 2007, non-ST elevation (NSTE) ACS patients were recruited in ACS I (n = 3295; 1999-2001), ACS II (n = 1956; 2002-2003), and GRACE (n = 6491; 2004-2007) in Canada. Using the four-variable Modified Diet in Renal Disease equation, we stratified the study population (n = 11,377) into three groups based on their estimated glomerular filtration rate (eGFR), and examined their treatment and outcome. While in-hospital use of coronary angiography and revascularization increased over time in all groups (P < 0.001), patients with kidney dysfunction were less likely to undergo invasive management (P < 0.001). Unadjusted 1 year mortality was lower among patients receiving in-hospital coronary angiography within all eGFR categories (> or =60 mL/min/1.73 m(2): 2.5 vs. 7.6%, P < 0.001; 30-59 mL/min/1.73 m(2): 8.0 vs. 14.6%, P < 0.001; <30 mL/min/1.73 m(2): 27.5 vs. 41.5%, P = 0.043). In-hospital revascularization was independently associated with lower 1-year mortality (adjusted OR = 0.52, 95% CI 0.36-0.77, P = 0.001), irrespective of eGFR (P for heterogeneity = 0.39). Underestimation of patient risk was the most common barrier to an invasive treatment strategy. CONCLUSION: Despite temporal increases in invasive management of NSTE-ACS, patients with kidney dysfunction are more commonly treated conservatively, with an associated worse outcome. In-hospital revascularization was independently associated with improved survival, irrespective of eGFR. Randomized controlled trials involving patients with kidney dysfunction are needed to confirm whether more aggressive treatment will improve their poor outcome.
No takes yet. Share an insight, caveat, or question.
Wong et al. (2009) conducted an observational in Non-ST elevation acute coronary syndromes (NSTE-ACS) (n=11,377). In-hospital revascularization vs. Conservative management was evaluated on 1-year mortality (adjusted OR 0.52, 95% CI 0.36-0.77, p=0.001). In-hospital revascularization was independently associated with lower 1-year mortality in patients with non-ST elevation acute coronary syndromes (adjusted OR 0.52; 95% CI 0.36-0.77; P=0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: