Later calendar years (2014-2015 vs 2007-2008) were associated with higher in-hospital mortality for STEMI patients with preserved renal function (OR 1.25; 95% CI 1.13-1.39; P<0.001).
Cohort (n=832,272)
Yes
Does the utilization of evidence-based therapies and in-hospital mortality for myocardial infarction change over time according to the degree of chronic kidney disease?
Utilization of evidence-based therapies for MI has increased over the past decade across all CKD stages, with corresponding improvements in in-hospital mortality for NSTEMI but not STEMI patients with CKD.
Odds Ratio: 1.25 (95% CI 1.13–1.39)
p-value: p=<0.001
Background We sought to determine temporal trends in use of evidence‐based therapies and clinical outcomes among myocardial infarction ( MI) patients with chronic kidney disease ( CKD ). Methods and Results MI patients from the NCDR (National Cardiovascular Data Registry) Chest Pain– MI Registry between January 2007 and December 2015 were categorized into 3 groups by degree of CKD (end‐stage renal disease on dialysis, CKD glomerular filtration rate <60 mL/min per 1.73 m 2 not requiring dialysis, and no CKD glomerular filtration rate ≥60 mL/min per 1.73 m 2 ). Logistic regression modeling was used to determine the association between calendar years (2014–2015 versus 2007–2008) and each outcome by degree of CKD . Among 325 396 patients with ST‐segment–elevation MI, 1.0% had end‐stage renal disease requiring dialysis, and 26.1% had CKD not requiring dialysis. Use of primary percutaneous coronary intervention increased over time regardless of the presence or degree of CKD ( P= 0.40 for interaction). In‐hospital mortality was temporally higher among patients with preserved renal function (odds ratio: 1.25; 95% confidence interval, 1.13–1.39; P <0.001) but not among patients with CKD ( P =0.035 for interaction). Among 506 876 non–ST‐segment–elevation MI patients, 3.4% had end‐stage renal disease requiring dialysis, and 34.4% had CKD not requiring dialysis. P2Y 12 inhibitor use within 24 hours increased over time only among dialysis patients ( P for interaction <0.001). Use of coronary angiography and percutaneous coronary intervention also increased, with the greatest increase among dialysis patients ( P for interaction <0.001 and <0.001, respectively). In‐hospital mortality was lower, regardless of the presence or degree of CKD ( P =0.64 for interaction). Conclusions Uptake of evidence‐based medical and invasive therapies has increased over the past decade among MI patients with CKD , particularly dialysis patients, with improvement of in‐hospital mortality observed among patients with non–ST‐segment–elevation MI, but not ST‐segment–elevation MI, and CKD .
Bagai et al. (Wed,) conducted a cohort in Myocardial Infarction with Chronic Kidney Disease (n=832,272). Calendar years 2014-2015 vs. Calendar years 2007-2008 was evaluated on In-hospital mortality (STEMI patients with preserved renal function) (OR 1.25, 95% CI 1.13-1.39, p=<0.001). Later calendar years (2014-2015 vs 2007-2008) were associated with higher in-hospital mortality for STEMI patients with preserved renal function (OR 1.25; 95% CI 1.13-1.39; P<0.001).