title: Routine invasive strategy in acute coronary syndrome patients with renal dysfunction. Results of the ARIAM-SEMICYUC registry.
abstract: OBJECTIVE
  To evaluate the use and effectiveness of a routine invasive strategy (RIS) in patients with acute coronary syndrome without persistent ST-segment elevation with renal dysfunction in the real world scenario.
  
  
  METHODS
  A retrospective cohort study based on the ARIAM-SEMICYUC Registry (2011-2014) was carried out. Renal dysfunction was defined as GFR (Cockroft-Gault)<60ml/min (moderate dysfunction) or<30ml/min (severe dysfunction). Patients in which early angiography (<72h) was performed due to cardiogenic shock or recurrent myocardial ischemia were excluded. The primary endpoint was hospital mortality. Confounding factors were controlled using propensity score analysis.
  
  
  RESULTS
  A total of 4,279 patients were analyzed, of which 26% had moderate renal dysfunction and 5% severe dysfunction. Patients with renal dysfunction had greater severity and comorbidity, higher hospital mortality (8.6 vs. 1.8%), and lesser use of the RIS (40 vs. 52%). The adjusted OR for mortality in patients without/with renal dysfunction were 0.38 (95% confidence interval [95%CI] 0.17 to 0.81) and 0.52 (95%CI 0.32 to 0.87), respectively (interaction P-value=.4779). The impact (adjusted risk difference) of RIS was higher in the group with renal dysfunction (-5.1%, 95%CI -8.1 to -2.1 vs. -1.6%, 95%CI -2.6 to -0.6; interaction P-value=.0335). No significant interaction was detected for the other endpoints considered (ICU mortality, 30-day mortality, myocardial infarction, acute renal failure or moderate/severe bleeding).
  
  
  CONCLUSIONS
  The results suggest that the effectiveness of IRS is similar in patients with normal or abnormal renal function, and alert to the under-utilization of this strategy in such patients.
authors.affiliation: Hospital General Universitario de Elche, Elche, Alicante, España. Electronic address: jlatour@coma.es.
authors.forename: J
authors.initials: J
authors.lastname: Latour-Pérez
authors.affiliation: Hospital Moncloa, Madrid, España.
authors.forename: V
authors.initials: V
authors.lastname: Gómez-Tello
authors.affiliation: Hospital General Universitario de Elche, Elche, Alicante, España.
authors.forename: E
authors.initials: E
authors.lastname: de-Miguel-Balsa
authors.affiliation: Hospital General Universitario de Elche, Elche, Alicante, España.
authors.forename: A
authors.initials: A
authors.lastname: Llamas-Álvarez
authors.affiliation: Hospital Universitari Son Espases, Palma de Mallorca, España.
authors.forename: A
authors.initials: A
authors.lastname: Carrillo-López
authors.affiliation: Hospital Universitario Nuestra Señora de Valme, Sevilla, España.
authors.forename: J A
authors.initials: JA
authors.lastname: Sánchez-Román
authors.affiliation: Hospital General de Castelló, Castelló, España.
authors.forename: J
authors.initials: J
authors.lastname: Ruíz-Ruíz
authors.affiliation: Hospital General Universitario de Ciudad Real, Ciudad Real, España.
authors.forename: M C
authors.initials: MC
authors.lastname: Martín-Rodríguez
authors.affiliation: Hospital Universitario Arquitecto Marcide-Novoa Santos, Ferrol, La Coruña, España.
authors.forename: C J
authors.initials: CJ
authors.lastname: Fernández-González
authors.affiliation: Complejo Hospitalario Universitario de Cartagena, Cartagena, Murcia, España.
authors.forename: J A
authors.initials: JA
authors.lastname: Fernández-Lozano
authors.affiliation: Hospital General Universitario de Elche, Elche, Alicante, España.
authors.forename: C
authors.initials: C
authors.lastname: Picazos Vicente
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007674:Kidney Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D000072658:Non-ST Elevated Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D057216:Propensity Score; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Acute coronary syndrome; Disfunción renal; Intervención coronaria percutánea; Mortalidad; Mortality; Percutaneous coronary intervention; Registries; Registros; Renal dysfunction; Síndrome coronario agudo