Optimal time for catheterization in NSTE-ACS patients with impaired renal function: insights from the ABOARD Study.
BACKGROUND
To assess the impact of impaired renal function (IRF) and timing of catheterization (immediate versus delayed intervention) on outcomes in intermediate/high risk NSTE-ACS patients.


METHODS
We performed a post-hoc analysis of the randomized ABOARD population to compare 1) patients with vs. without IRF and 2) the two intervention strategies in patients with IRF. A creatinine clearance <60 mL/min defined IRF. The primary endpoint was the in-hospital peak troponin I value; the secondary endpoints were a) the composite of death, myocardial infarction, urgent revascularization or recurrent ischemia (death/MI/UR/RI) and b) STEEPLE major bleeding (MB) at 1-month follow-up.


RESULTS
Among the 345 patients, 75 (21.7%) had IRF. Patients with IRF were older, had more comorbidities and were at higher cardiovascular risk. Radial catheterization was predominant (84%). Among IRF patients, 37 (49%) and 38 (51%) patients were randomized to an immediate and delayed strategy, respectively. The primary and secondary endpoints rates were not different for the two comparisons. IRF was associated with more death (5.3% vs. 1.1%, p=0.043) and non-CABG MB (9.3% vs. 2.2%, p=0.001). In patients with IRF, a delayed strategy was associated with more recurrent ischemia (28.9% vs. 8.1%, p=0.021). Absence of clopidogrel pretreatment, insulin therapy and left main culprit lesion were independently associated with death/MI/UR/RI, while age and CABG surgery were related with MB.


CONCLUSIONS
IRF is associated with worse outcomes in NSTE-ACS patients. The primary results of the ABOARD study apply also to patients with IRF in which the timing of catheterization does not impact hard outcomes.
Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Université Paris 6, INSERM CMR 937, Paris, France.
O
O
Barthélémy
G
G
Cayla
J
J
Silvain
S A
SA
O'Connor
A
A
Bellemain-Appaix
F
F
Beygui
G
G
Sideris
O
O
Varenne
J P
JP
Collet
E
E
Vicaut
G
G
Montalescot
D054058:Acute Coronary Syndrome / Q000097:blood* / Q000453:epidemiology / Q000628:therapy*; D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000097:blood* / Q000453:epidemiology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*
D019210:Troponin I