Abstract 14628: Characteristics and In-hospital Outcomes of Patients With Non-ST-Segment Elevation Myocardial Infarction and Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention.
Objective: Despite the high prevalence of chronic kidney disease (CKD), randomized trials that addressed the benefit of an invasive strategy in acute coronary syndromes excluded patients with advanced CKD. The aim of our study is to evaluate the characteristics and outcomes of patients with various stages of CKD presenting with non-ST-segment elevation myocardial infarction (NSTEMI) and managed with percutaneous coronary intervention (PCI).
Methods: We examined data on 40,074 NSTEMI patients managed with PCI between January 2007 and September 2009 who were captured by the ACTION Registry-GWTG. Patients were divided based on baseline renal function in 4 groups: 1) no CKD, 2) CKD stage 3, 3) CKD stage 4, 4) CKD stage 5.
Results: Compared to patients with normal renal function, CKD patients managed with PCI had significantly more history of myocardial infarction, heart failure and 3-vessel coronary artery disease (Table). They also received less antiplatelet and anticoagulant therapy but were treated more frequently with bivalirudin. Patients with progressively more severe CKD undergoing PCI had higher rates of in-hospital mortality, heart failure, recurrent infarction, and major bleeding; CKD stage 4 was associated with the highest risk of adverse events (Table).
Conclusions: CKD patients presenting with NSTEMI and managed with PCI have more comorbidities than patients without CKD and are less frequently treated with the recommended ACS therapies. CKD is a powerful predictor of in-hospital ischemic and bleeding events in patients undergoing PCI.
- © 2010 by American Heart Association, Inc.