Abstract 5577: Short-Term Outcomes of STEMI and NSTEMI in Patients with Chronic Kidney Disease: A Report from the National Cardiovascular Data ACTION Registry
Chronic kidney disease (CKD) is a risk factor for myocardial infarction (MI) and death. However, the relationship between severity of CKD and contemporary hospital-based management and outcomes across the spectrum of MI (STEMI and NSTEMI) has not been well-documented. The study population was drawn from the ACTION Registry, a nation-wide sample of STEMI (n=19,481) and NSTEMI (n=30,462) patients admitted to 274 hospitals in the United States between January 1 and December 31, 2007. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation and categorized as ≥60, 30 to <60, 15 to <30 and eGFR<15 mL/min/1.73m2 or dialysis. Use of acute (first 24 hours) therapies and early (first 48 hours) cardiac catheterization as well as in-hospital major bleeds, and death were compared across CKD stages in models adjusted for demographics, CVD history and prior procedures, and risk factors. Overall, 30.5% and 42.9% of patients with STEMI and NSTEMI, respectively, had CKD Stage III or greater (eGFR<60 ml/min/1.73m2 or dialysis). Regardless of MI type, patients with CKD were less likely to receive acute evidence-based therapies including aspirin, beta-blockers or clopidogrel or to undergo early invasive care and were more likely to experience a major bleed or death (Table⇓). There were 1030 deaths among those presenting with STEMI, and 1223 among those with NSTEMI. There was a greater relative increase in death for patients with STEMI with advancing CKD stage than was seen in NSTEMI (P interaction <0.0001 for each stage). A large proportion of patients presenting with STEMI or NSTEMI have CKD. Further efforts to address treatment gaps in the management of MI in the presence of CKD are needed to improve outcomes in this high-risk population.