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Acute kidney injury requiring dialysis and in-hospital mortality in patients with chronic kidney disease and non-ST-segment elevation acute coronary syndrome undergoing early vs delayed percutaneous coronary intervention: A nationwide analysis.

ABSTRACT: BACKGROUND:Chronic kidney disease (CKD) is a well-known risk factor for coronary artery disease and is associated with poor outcomes following an acute coronary syndrome (NSTE-ACS). The optimal timing of an invasive strategy in patients with CKD and NSTE-ACS is unclear. HYPOTHESIS:Timing of PCI in CKD patients will not affect the risk of mortality or incidence of dialysis. METHODS:We queried the National Inpatient Sample database (NIS) to identify cases with NSTEMI and CKD. Patients who underwent percutaneous coronary intervention (PCI) day 0 or 1 vs day 2 or 3 after admission were categorized as early vs delayed PCI, respectively. The primary outcomes of the study were in-hospital mortality and acute kidney injury requiring hemodialysis (AKI-D). The secondary outcomes were length of stay and hospital charges. Baseline characteristics were balanced using propensity score matching (PSM). RESULTS:After PSM, 3708 cases from the delayed PCI group were matched with 3708 cases from the early PCI group. The standardized mean differences between the 2 groups were substantially reduced after PSM. All other recorded variables were balanced between the 2 groups. In the early and delayed PCI groups, the incidence of AKI-D (2.5% vs 2.3%; P = 0.54) and in-hospital mortality (1.9% vs 1.4%; P = 0.12) was similar. Hospital charges and length of stay were higher in the delayed PCI group. CONCLUSIONS:The incidence of AKI-D and in-hospital mortality among patients with CKD and NSTE-ACS were not significantly affected by the timing of PCI. However, delayed PCI added significant cost and length of stay. A prospective randomized study is required to validate this concept.

SUBMITTER: Patel B

PROVIDER: S-EPMC6490607 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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Acute kidney injury requiring dialysis and in-hospital mortality in patients with chronic kidney disease and non-ST-segment elevation acute coronary syndrome undergoing early vs delayed percutaneous coronary intervention: A nationwide analysis.

Patel Brijesh B Carson Philip P Shah Mahek M Garg Lohit L Agarwal Manyoo M Agrawal Sahil S Arora Shilpkumar S Steigerwalt Susan S Bavry Anthony A Dusaj Raman R Patel Nainesh N Feldman Bruce B

Clinical cardiology 20171220 12

<h4>Background</h4>Chronic kidney disease (CKD) is a well-known risk factor for coronary artery disease and is associated with poor outcomes following an acute coronary syndrome (NSTE-ACS). The optimal timing of an invasive strategy in patients with CKD and NSTE-ACS is unclear.<h4>Hypothesis</h4>Timing of PCI in CKD patients will not affect the risk of mortality or incidence of dialysis.<h4>Methods</h4>We queried the National Inpatient Sample database (NIS) to identify cases with NSTEMI and CKD. ...[more]

PMID: 29266282

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Project description:BackgroundPrimary percutaneous coronary intervention (PPCI) has been widely recognized as the preferred treatment for ST-segment-elevation myocardial infarction (STEMI). However, substantial numbers of STEMI patients cannot receive timely PPCI. Early fibrinolysis followed by routine percutaneous coronary intervention (FPCI) has been proposed as an effective and safe alternative for eligible patients. To date, few studies have compared FPCI with PPCI in terms of microvascular reperfusion. This study aimed to evaluate the microvascular function of FPCI and PPCI.MethodsSTEMI patients at the Peking University First Hospital and Miyun Hospital were enrolled in this retrospective study between January 2015 to December 2020. Microvascular function documented by the coronary angiography-derived index of microvascular resistance (caIMR) was measured at the final angiogram after revascularization. The primary end point was the caIMR of the culprit vessels. The secondary end points were in-hospital and follow-up major adverse cardiovascular events (MACE), including cardiovascular death, non-fatal recurrent myocardial infarction, target-vessel revascularization (TVR), and non-fatal stroke/transient ischemic attacks (TIA). Details of the adverse clinical events were obtained from telephone interviews and electronic medical record systems until January 2022.ResultsIn total, 496 STEMI patients were enrolled in this cross-sectional retrospective study. Of these patients, 81 underwent FPCI, and 415 underwent PPCI. At the baseline, the PPCI patients had a higher-risk profile than the FPCI patients. The time from symptom onset to reperfusion therapy was significantly shorter in the FPCI group than the PPCI group (median 3.0 vs. 4.5 hours; P<0.001). The caIMR was significantly lower in the FPCI group than the PPCI group (median 20.34 vs. 40.33; P<0.001). The median follow-up duration was 4.1 years. During the follow-up period, the rate of MACE was lower in the FPCI group than the PPCI group [7 (10.1%) vs. 82 (20.8%), P=0.048]. After propensity score matching to adjust for the imbalances at the baseline, the caIMR remained significant and the clinical outcomes did not differ significantly between the two groups.ConclusionsIn eligible STEMI patients, clinically successful FPCI may be associated with better microvascular reperfusion and comparable clinical outcomes as compared with PPCI.

Dataset Information

Acute kidney injury requiring dialysis and in-hospital mortality in patients with chronic kidney disease and non-ST-segment elevation acute coronary syndrome undergoing early vs delayed percutaneous coronary intervention: A nationwide analysis.

Publications

Acute kidney injury requiring dialysis and in-hospital mortality in patients with chronic kidney disease and non-ST-segment elevation acute coronary syndrome undergoing early vs delayed percutaneous coronary intervention: A nationwide analysis.

Similar Datasets

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