Abstract 20205: Patients with Severe Chronic Kidney Disease have Survival Benefit from Initial Invasive Therapy and Early Revascularization after Acute Coronary Syndrome
Background: Early invasive strategy and revascularization are associated with improved outcomes after acute coronary syndrome (ACS). It is unclear whether their benefits persist in ACS patients with advanced CKD, who are often sub-optimally treated and excluded from clinical trials. We hypothesized that initial invasive strategy and early revascularization are associated with improved short-term and 1-year mortality after ACS.
Methods: We undertook meta-analyses of short-term (in-hospital or 30-day) and 1-year mortality in studies examining the effectiveness of early invasive therapy and early revascularization in patients with ACS across various CKD stages (estimated by GFR). A search of Medline and Cochrane databases and conference proceedings between 1995 and 2010 identified 9 published reports enrolling 28,142 patients with CKD (GFR < 90 mL<52>min−1<52>1.73 m−2), of whom 10,786 received early revascularization and 17,356 received initial medical therapy. The same search method identified 8 reports of 27,430 patients, of whom 8,820 received initial invasive strategy and 18,610 received initial conservative strategy. Summary odds ratios were calculated using random-effects models.
Results: Compared with initial medical therapy, early revascularization of patients with ACS and CKD was associated with reduced 12-month mortality across all CKD stages, with the magnitude of benefit diminishing with decreasing renal function (Table). Compared with initial conservative strategy, initial invasive strategy in patients with ACS was also associated with reduced 12-month mortality across available CKD stages. Furthermore, among ACS patients with severe CKD both strategies were associated with short-term survival benefit.
Conclusions: Initial invasive strategy and early revascularization after ACS are associated with increased short-term and 1-year survival in patients with CKD, including those with severe CKD or receiving dialysis.
- Acute coronary syndromes
- Coronary artery disease
- Percutaneous coronary intervention
- Renal function
- © 2010 by American Heart Association, Inc.