Abstract 19987: Differences in Utilization of Anti-Thrombotic Therapies and Invasive Cardiac Procedures for Myocardial Infarction by Degree of Chronic Kidney Disease: A Report From the ACTION Registry - GWTG
Introduction: Worse clinical outcomes after myocardial infarction (MI) in patients with chronic kidney (CKD) may be in part attributable to lower use of guideline recommended therapies.
Methods: MI patients from the ACTION registry-GWTG between 01/2007 and 12/2014 were stratified by STEMI and NSTEMI, and categorized into 3 groups based on the degree of CKD [end-stage renal disease (ESRD) on dialysis, CKD (GFR<60ml/min/1.73m2) not on dialysis, and no CKD (GFR>=60ml/min/1.73m2)]. Treatment with anti-thrombotic therapies and coronary revascularization were compared between groups using chi-square test.
Results: We included 690,514 patients [39.1% STEMI, 60.9% NSTEMI) from 804 US hospitals. STEMI patients with CKD were treated less frequently with aspirin or a P2Y12 receptor inhibitor within 24 hours and anticoagulation in-hospital compared with patients without CKD, with lowest use in ESRD patients on dialysis (Table). STEMI patients with CKD were also less likely to undergo coronary angiography; however, among those who underwent angiography, percentage of primary PCI and CABG was similar regardless of the presence or degree of CKD. Lower use of aspirin, P2Y12 receptor inhibitor, anticoagulation and coronary angiography, both among ESRD patients on dialysis and those with CKD not requiring dialysis, was also observed among NSTEMI patients. However, unlike STEMI, among patients with NSTEMI undergoing angiography, both PCI and CABG were performed less frequently in patients with ESRD on dialysis and CKD not requiring dialysis compared with patients without CKD.
Conclusions: CKD patients, particularly ESRD patients on dialysis are less likely than non-CKD patients to be treated with guideline-recommended therapies during a MI hospitalization. Underutilization of coronary revascularization in patients with CKD is more prevalent in NSTEMI compared with STEMI. These findings demonstrate an opportunity to improve care in this high-risk population.
Author Disclosures: A. Bagai: Honoraria; Modest; Astra Zeneca. Ownership Interest; Modest; Soundbite. Consultant/Advisory Board; Modest; Astra Zeneca. D. Lu: None. J. Lucas: None. A. Goyal: None. J. Garvey: Research Grant; Modest; Philips healthcare. Consultant/Advisory Board; Modest; Philips healthcare. T.Y. Wang: Research Grant; Modest; Gilead Sciences, Eli Lilly, Daiichi Sanyo, Astra Zeneca, Boston Scientific, Regeneron, GlaxoSmithKline. Honoraria; Modest; Astra Zeneca, Eli Lilly, Pfizer. S.G. Goodman: Consultant/Advisory Board; Modest; Astra Zeneca, Bayer, Bristol Myers Squibb, Daiichi-Sankyo, Eli Lilly, Sanofi. M.T. Roe: Research Grant; Significant; Astra Zeneca, Eli Lilly & Co., Janssen Pharmaceuticals, Sanofi-Aventis, Daiichi-Sankyo, Ferring Pharmaceuticals, Familial Hypercholesterolemia Foundation. Honoraria; Modest; Amgen, Bristol Myers Squibb. Consultant/Advisory Board; Modest; Astra Zeneca, Eli Lilly & Co., Daiichi-Sankyo, Amgen, PriMed, Myokardia, Boehringer-Ingelheim. Consultant/Advisory Board; Significant; Merck & Co..
- © 2016 by American Heart Association, Inc.