Abstract 5591: Early Invasive Therapy in Non-ST-elevation Myocardial Infarction Improves Survival Although Benefit Declines with Worsening Renal Function - Data from the Register of Information and Knowledge About Swedish Heart Intensive Care Admissions (RIKS-HIA)
To assess the use and benefit of an early invasive therapy in patients with non-ST-elevation myocardial infarction (NSTEMI) across renal function stages. Nationwide register, in which consecutive NSTEMI-patients (n=22584) treated at a coronary care unit between 2003–2006, ≤80 years, and who survived the first 14 days were included. Glomerular filtration rate (eGFR) was estimated from creatinine with the Modification of Diet in Renal Disease Study formula. Patients were divided into medically or invasively treated if they had either a percutaneous coronary intervention or coronary artery bypass graft surgery within 14 days of admission. A propensity score based on 44 baseline covariates to receive invasive therapy was calculated. A Cox regression model adjusting for propensity score, revascularization therapy and discharge medication was used to assess 1-year mortality. With propensity score adjustment there were no major differences in baseline characteristics between invasively or medically treated patients. There was a gradient with significantly fewer patients treated invasively with declining renal function: eGFR ≤90 63%, eGFR 60 – 89 56%, eGFR 30 –59 36%, eGFR 15–29 14%, eGFR <15/dialysis 17% (p<0.001). Overall 1-year mortality was reduced with an invasive strategy (Figure⇓). Across renal function groups the benefit of an early invasive therapy was maintained in normal-moderate renal insufficiency, but seemed to decline in severe kidney dysfunction or kidney failure. Early invasive therapy improves survival in NSTEMI patients but the benefit declines in those with most advanced renal insufficiency.