title: Impact of optimal medical therapy and revascularization on outcome of patients with chronic kidney disease and on dialysis who presented with acute coronary syndrome.
abstract: Coronary artery disease is the main cause of death in patients with chronic kidney disease (CKD). The poor prognosis associated with acute coronary syndrome (ACS) in these patients has been related to therapeutic nihilism. This study included 2,357 patients with ACS who had percutaneous coronary intervention. According to their creatinine clearance and medical history, they were divided into 3 groups: dialysis (n = 73); CKD (n= 293); and control (n= 1,991). Rates of cardiovascular events were recorded during a 1-year follow-up period. Patients in all groups received similar contemporary therapy for ACS, including percutaneous coronary intervention and optimal medial therapy. On admission, patients with CKD and patients on dialysis more often presented with cardiogenic shock (p = 0.05 and 0.02, respectively). A graded increase in the rate of major adverse cardiovascular events at 1 year was observed with decreasing renal function (control 13%, CKD 22.9%, dialysis 45.2%, p <0.001 for all comparisons). In multivariate analysis, patients with CKD and on dialysis were significantly associated with 1-year major adverse cardiac events with adjusted hazard ratios of, respectively, 1.5 (95% confidence interval 1.1 to 2.1; p = 0.009) and 2.7 (95% confidence interval 1.7 to 4.1; p <0.001). In conclusion, despite optimal contemporary medical therapy and revascularization, the prognosis of patients with CKD and, in particular, of patients undergoing dialysis, remains poor.
authors: Department of Internal Medicine, Division of Cardiology, Washington Hospital Center, Washington, DC, USA.
authors: Laurent
authors: L
authors: Bonello
authors: Axel
authors: A
authors: De Labriolle
authors: Probal
authors: P
authors: Roy
authors: Daniel H
authors: DH
authors: Steinberg
authors: Teruo
authors: T
authors: Okabe
authors: Tina L
authors: TL
authors: Pinto Slottow
authors: Zhenyi
authors: Z
authors: Xue
authors: Rebecca
authors: R
authors: Torguson
authors: William O
authors: WO
authors: Suddath
authors: Lowell F
authors: LF
authors: Satler
authors: Kenneth M
authors: KM
authors: Kent
authors: Augusto D
authors: AD
authors: Pichard
authors: Joseph
authors: J
authors: Lindsay
authors: Ron
authors: R
authors: Waksman
mesh_terms: D000208:Acute Disease; D000368:Aged; D016001:Confidence Intervals; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D003401:Creatine / Q000378:metabolism; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000378:metabolism / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D016017:Odds Ratio; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D003401:Creatine