The Dilemma of Renal Dysfunction and Coronary Artery Revascularization

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: Non-ST-segment elevation myocardial infarction (NSTEMI) stratified by baseline renal function (n=15255). Intervention: Percutaneous coronary intervention (PCI) vs. Non-PCI management. Primary outcome: 3-year major adverse cardiac and cerebrovascular events (MACCE: all-cause death, recurrent myocardial infarction, or stroke) (HR 0.58 (eGFR 60-89), HR 0.66 (eGFR 30-59), HR 0.60 (eGFR <30)).

Wenhui Li; Łukasz Kuźma; Gregory Y.H. Lip

doi:10.1016/j.jacasi.2026.07.012

September 1, 2026JACC AsiaOpen Access

The Dilemma of Renal Dysfunction and Coronary Artery Revascularization

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Key Points

To assess whether percutaneous coronary intervention improves 3-year clinical outcomes across varying stages of renal function in patients presenting with non-ST-segment elevation myocardial infarction.
Editorial analysis of a pooled registry cohort from KAMIR-NIH and KAMIR-V comprising 15,255 patients with NSTEMI (12,982 managed with PCI and 2,273 without PCI).
Patients were stratified into four baseline eGFR categories (≥90, 60-89, 30-59, and <30 mL/min/1.73 m²) to evaluate 3-year major adverse cardiac and cerebrovascular events (MACCE), defined as all-cause death, recurrent myocardial infarction, or stroke.
Recurrent myocardial infarction did not differ consistently after adjustment across strata, showing that the observed association was driven primarily by lower all-cause mortality.
The findings were subject to strong confounding by indication, characterized by insufficient propensity score overlap between groups and incomplete ascertainment of contrast-associated acute kidney injury and bleeding.

PICO

P

Population

15,255 Asian patients with non-ST-segment elevation myocardial infarction from the nationwide KAMIR-NIH and KAMIR-V registries, stratified by baseline eGFR and followed for 3 years.

E

Exposure / Comparator

Percutaneous coronary intervention (PCI) vs Non-PCI management

O

Primary Outcome

3-year major adverse cardiac and cerebrovascular events (MACCE: all-cause death, recurrent myocardial infarction, or stroke) — HR 0.58 (eGFR 60-89), HR 0.66 (eGFR 30-59), HR 0.60 (eGFR <30)

Main Result

Hazard Ratio: 0.58

Limitations

Strong confounding by indication due to non-randomized observational treatment assignment
Insufficient propensity score overlap for matching, inverse probability weighting, or overlap weighting
Residual confounding from unmeasured factors including frailty, proteinuria, dialysis status, lesion complexity, medication adherence, and patient preference
Incomplete data on contrast-associated acute kidney injury and periprocedural complications
Inability to fairly compare bleeding between PCI and non-PCI groups due to differing antiplatelet strategies
Exclusion of coronary artery bypass grafting from the main comparison
exclusively Asian cohort, which may limit generalizability due to ethnic differences in thrombotic and bleeding outcomes

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Implication

Observational registry analysis finds lower 3-year MACCE with PCI across lower eGFR strata in NSTEMI, suggesting renal dysfunction alone should not preclude coronary revascularization.

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Cite This Study

Li et al. (2026) conducted an editorial in Non-ST-segment elevation myocardial infarction (NSTEMI) stratified by baseline renal function (n=15,255). Percutaneous coronary intervention (PCI) vs. Non-PCI management was evaluated on 3-year major adverse cardiac and cerebrovascular events (MACCE: all-cause death, recurrent myocardial infarction, or stroke) (HR 0.58 (eGFR 60-89), HR 0.66 (eGFR 30-59), HR 0.60 (eGFR <30)).

synapsesocial.com/papers/6a996550636c6408cfa7f8ba https://doi.org/10.1016/j.jacasi.2026.07.012

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The Dilemma of Renal Dysfunction and Coronary Artery Revascularization

Key Points

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

The Dilemma of Renal Dysfunction and Coronary Artery Revascularization

Key Points

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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