Abstract 5015: Thrombolysis in Myocardial Infarction (TIMI) Risk Score and Mortality in Patients with Advanced Chronic Kidney Disease (CKD) and on Dialysis
Mortality is increased among chronic kidney disease (CKD) patients who present with non-ST elevation acute coronary syndromes (NSTE-ACS) and undergo percutaneous coronary intervention (PCI) compared to those without CKD. Many risk stratification tools have demonstrated poor accuracy in CKD cohorts. We assessed the prognostic capability of the thrombolysis in myocardial infarction (TIMI) risk score for unstable angina/non-ST elevation MI in CKD patients who presented with NSTE-ACS and underwent PCI. Mortality data for 6940 consecutive patients who presented with NSTE-ACS and underwent PCI between July 1, 1999 and June 30, 2007 were obtained. Patients were categorized by estimated glomerular filtration rate (eGFR): >60 ml/min/1.73m2 (n=4938), 30 –59 ml/min/1.73m2 (n=1938), <30 ml/min/1.73m2 (n<202) and on dialysis (n=208). Mortality rates and hazard ratios of all-cause mortality associated with TIMI risk score levels (0 –2, 3– 4, ≥5) were calculated within each eGFR category. Over a median follow-up of 3.2 years, 813 deaths occurred. Within each eGFR category, including patients on dialysis, there was a stepwise increase in mortality rates across TIMI risk score levels (Figure⇓). Patterns of increasing sex-race adjusted hazard ratios of mortality associated with higher TIMI risk score levels were present within each eGFR category and for dialysis patients. The TIMI risk score discriminates mortality risk among patients across the full range of CKD, including patients on dialysis, who present with NSTE-ACS and undergo PCI.