Characteristics and in-hospital outcomes of patients presenting with non–ST-segment elevation myocardial infarction found to have significant coronary artery disease on coronary angiography and managed medically: Stratification according to renal function - 13/07/12
, Anita Y. Chen, MS b , Matthew T. Roe, MD c, Jorge F. Saucedo, MD d Résumé |
Background |
The characteristics, therapies, and outcomes of patients presenting with non–ST-segment elevation myocardial infarction, found to have significant coronary artery disease on coronary angiography, and managed without revascularization (“nonrevascularized patients”) have not been evaluated previously in a large-scale registry.
Methods |
We examined data on 13,872 non–ST-segment elevation myocardial infarction nonrevascularized patients who were captured by the Acute Coronary Treatment and Intervention Outcomes Network registry. Patients were divided according to baseline renal function in 4 groups: no chronic kidney disease (CKD) and CKD stages 3, 4, and 5.
Results |
The in-hospital mortality of nonrevascularized patients was 3.7%, whereas their in-hospital major bleeding rate was 10.8%. Overall, 44.2% (n = 6,132) of nonrevascularized patients had CKD. Compared with patients with normal renal function, nonrevascularized patients with CKD had significantly more history of myocardial infarction, heart failure, more 3-vessel coronary artery disease, and received fewer antithrombotic therapies. In addition, they had significantly higher rates of in-hospital mortality and major bleeding; CKD stage 4 was associated with the highest risk of adverse events. The multivariable-adjusted odds ratios of in-hospital mortality for CKD stages 3, 4, and 5 relative to no CKD were 1.5, 2.5, and 2.2, respectively (global P < .0001), and the analogous adjusted odds ratios of major bleeding were 1.5, 2.5, and 1.8 (global P < .0001).
Conclusion |
Nonrevascularized patients have a high in-hospital mortality. Nonrevascularized patients with CKD have more comorbidities than patients without CKD and less frequently receive guideline-recommended therapies. Chronic kidney disease is strongly associated with in-hospital mortality and bleeding.
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| This manuscript is an original research that has not been published and is not under consideration elsewhere. All of the authors had access to the data, participated in the preparation of the manuscript, and approve its content. |
Vol 164 - N° 1
P. 52 - juillet 2012 Retour au numéro
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