Early angiography in patients with chronic kidney disease: a collaborative systematic review.
OBJECTIVE
In the general population, an early invasive strategy of routine coronary angiography is superior to a conservative strategy of selective angiography in patients who are admitted with unstable angina or non-ST segment elevation myocardial infarction (MI), but the effectiveness of this strategy in individuals with chronic kidney disease (CKD) is uncertain.


METHODS
We conducted a collaborative meta-analysis with data provided by the main authors of identified trials to estimate the effectiveness of early angiography in patients with CKD. The Cochrane, Medline, and EMBASE databases were searched to identify randomized trials that compared invasive and conservative strategies in patients with unstable angina or non-ST MI. Pooled risks ratios were estimated using data from enrolled patients with estimated GFR <60 ml/min per 1.73 m(2).


RESULTS
Five randomized trials that enrolled 1453 patients with CKD were included. An early invasive strategy was associated with nonsignificant reductions in all-cause mortality, nonfatal MI, and a composite of death or nonfatal MI. The invasive strategy significantly reduced rehospitalization.


CONCLUSIONS
This collaborative study suggests that the benefits of an early invasive strategy are preserved in patients with CKD and that an early invasive approach reduces the risk for rehospitalization and is associated with trends of reduction in the risk for death and nonfatal re-infarction in patients with CKD. Coronary angiography should be considered for patients who have CKD and are admitted with non-ST elevation acute coronary syndromes.
Renal Division and Clinical Biometrics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. dcharytan@partners.org
David M
DM
Charytan
Lars
L
Wallentin
Bo
B
Lagerqvist
Rudolf
R
Spacek
Robbert J
RJ
De Winter
Noam M
NM
Stern
Eugene
E
Braunwald
Christopher P
CP
Cannon
Niteesh K
NK
Choudhry
D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000453:epidemiology; D017023:Coronary Angiography; D042241:Early Diagnosis; D006801:Humans; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D016032:Randomized Controlled Trials as Topic; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012307:Risk Factors