Early invasive treatment benefits patients with renal dysfunction in unstable coronary artery disease.
BACKGROUND
Few studies have investigated the effects of an early revascularization in relation to renal function in patients with unstable coronary artery disease (CAD).


METHODS
Patients (n = 2457) with unstable CAD randomized to a noninvasive or invasive treatment strategy in the Fast Revascularisation during InStability in Coronary artery disease (FRISC-II) trial were stratified according to tertiles of creatinine clearance (CrCl < 69 mL/min, CrCl 69-90 mL/min, CrCl > 90 mL/min) and followed for 2 years regarding death and/or myocardial infarction (MI).


RESULTS
In the noninvasive cohort, the rate of death or MI at 2 years was 22.4% at CrCl < 69 mL/min, 14.6% at CrCl 60-90 mL/min, and 11.6% at CrCl > 90 mL/min. In the invasive cohort, the rate of death or MI was reduced to 14.6% (P = .003) at CrCl < 69 mL/min and to 9.9% (P = .048) at CrCl 69 to 90 mL/min, but no significant reduction (11.2%) at CrCl > 90 mL/min. In a logistic regression analysis adjusting for other important covariables, CrCl < 69 mL/min remained independently associated with the risk of the combined end point in the noninvasively treated group (odds ratio, 1.96; 95% confidence interval, 1.12-3.42) but not in the invasively treated group (odds ratio, 1.09; 95% confidence interval, 0.56-2.14). When the interaction term for treatment strategy and CrCl group was included in the analysis, the interaction between treatment strategy and CrCl <90 mL/min was independently associated with the risk of future MI (P = .006).


CONCLUSIONS
In unstable CAD, an early invasive treatment strategy reduces the long-term risk of future death and MI in patients with mildly to moderately reduced CrCl.
Johnston
Nina
N
Department of Medical Sciences, Cardiology, Cardiothoracic Center, University Hospital, Uppsala, Sweden. nina.johnston@akademiska.se
Jernberg
Tomas
T
Lagerqvist
Bo
B
Wallentin
Lars
L
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
D003404:Creatinine