title: Timing of coronary angiography and outcome in patients with non-ST elevation acute coronary syndromes and kidney disease: real-world data from the acute coronary syndromes Israeli survey.
abstract: OBJECTIVE
  Patients with kidney disease (KD) who present with non-ST segment elevation acute coronary syndromes (NSTE-ACS) may benefit from coronary intervention. We evaluated the outcome of these patients who were referred for early or late coronary angiography.
  
  
  METHODS
  The risk of 1-year mortality according to the presence of KD [estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2)] and the time of coronary angiography [categorized as early (≤48 h from admission) or late (>48 h from admission)] was assessed among 2,001 NSTE-ACS patients enrolled in the ACS Israeli Survey between 2004 and 2008. A propensity score for early angiography was included in the proportional hazards modeling of mortality.
  
  
  RESULTS
  Patients with KD (n = 729) experienced a 2.7-fold increased risk of death compared with non-KD patients (p < 0.001). Early coronary angiography was associated with a lower rate of in-hospital complications and 30-day mortality. Both early and late angiography were associated with a lower adjusted risk of 1-year mortality [hazard ratios (HRs) 0.46 (p < 0.001) and 0.59 (p = 0.002), respectively] compared with no angiography. In patients with severe KD (eGFR <30 ml/min/1.73 m(2)), only early coronary angiography was associated with a lower mortality risk (HR 0.25, 95% confidence interval 0.08-0.81).
  
  
  CONCLUSIONS
  An early invasive strategy is associated with a low mortality risk in NSTE-ACS patients with KD and a more pronounced effect among those with severe KD.
authors: Department of Cardiology, Assaf Harofeh Medical Center, Zerifin, Israel.
authors: Revital
authors: R
authors: Young Altahan
authors: Ilan
authors: I
authors: Goldenberg
authors: Lizzie
authors: L
authors: Kimron
authors: Alon
authors: A
authors: Barsheshet
authors: Victor
authors: V
authors: Guetta
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007557:Israel / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors