title: Management of non-ST-segment elevation acute myocardial infarction in patients with chronic kidney disease (from the Korea Acute Myocardial Infarction Registry).
abstract: The aim of this study was to compare clinical outcomes among early invasive (EI), deferred invasive (DI), and conservative strategies in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) and chronic kidney disease (CKD). High-risk patients with NSTEMI are believed to fare better with an EI strategy, but the optimal treatment for patients with NSTEMI and CKD is not known. In total 5,185 patients with acute NSTEMI were enrolled from the Korea Acute Myocardial Infarction Registry and followed for 1 year. Patients were divided into EI, DI, and conservative treatment groups and classified into 4 stages using references from the National Kidney Foundation. The invasive EI and DI groups were compared to the conservative groups, and the EI and DI groups were compared according to each renal function stage. At 1-year follow-up, mortality rates in the conservative group were significantly higher than in the invasive groups except for the severe CKD group. The benefit of the EI over the DI strategy, although there were no significant differences between the 2 groups, tended to decrease as renal function decreased. In conclusion, in the management of NSTEMI, an invasive strategy decreased mortality compared to a conservative strategy except for severe CKD. In the timing of an invasive strategy, the EI strategy was observed to be superior to the DI strategy in patients with mild CKD; however, this tendency reversed as renal function decreased. When patients with NSTEMI have severe CKD, a conservative or DI strategy with prescription of cardioprotective medications and prevention of further deterioration in renal function should be considered.
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Hachinohe
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Shigeru
authors.initials: S
authors.lastname: Saito
authors.forename: Khurshid
authors.initials: K
authors.lastname: Ahmed
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Hwang
authors.forename: Min Goo
authors.initials: MG
authors.lastname: Lee
authors.forename: Doo Sun
authors.initials: DS
authors.lastname: Sim
authors.forename: Keun-Ho
authors.initials: KH
authors.lastname: Park
authors.forename: Ju Han
authors.initials: JH
authors.lastname: Kim
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Hong
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.forename: Jung Chaee
authors.initials: JC
authors.lastname: Kang
authors.forename: Jong Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Shung Chull
authors.initials: SC
authors.lastname: Chae
authors.forename: Young Jo
authors.initials: YJ
authors.lastname: Kim
authors.forename: Seung Ho
authors.initials: SH
authors.lastname: Hur
authors.forename: In Whan
authors.initials: IW
authors.lastname: Seong
authors.forename: Taek Jong
authors.initials: TJ
authors.lastname: Hong
authors.forename: Donghoon
authors.initials: D
authors.lastname: Choi
authors.forename: Myeong Chan
authors.initials: MC
authors.lastname: Cho
authors.forename: Chong Jin
authors.initials: CJ
authors.lastname: Kim
authors.forename: Ki Bae
authors.initials: KB
authors.lastname: Seung
authors.forename: Wook Sung
authors.initials: WS
authors.lastname: Chung
authors.forename: Yang Soo
authors.initials: YS
authors.lastname: Jang
authors.forename: Seung Woon
authors.initials: SW
authors.lastname: Rha
authors.forename: Jang Ho
authors.initials: JH
authors.lastname: Bae
authors.forename: Seung Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: D017677:Age Distribution; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003324:Coronary Artery Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D004363:Drug Utilization; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D007674:Kidney Diseases / Q000145:classification / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D020521:Stroke / Q000453:epidemiology; D013318:Stroke Volume; D013997:Time Factors
chemical_list: D002316:Cardiotonic Agents; D005343:Fibrinolytic Agents