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Invasive Versus Medical Management in Patients With Chronic Kidney Disease and Non–ST‐Segment–Elevation Myocardial Infarction

BACKGROUND: The role of invasive management compared with medical management in patients with non–ST‐segment–elevation myocardial infarction (NSTEMI) and advanced chronic kidney disease (CKD) is uncertain, given the increased risk of procedural complications in patients with CKD. We aimed to compare...

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Autores principales: Majmundar, Monil, Ibarra, Gabriel, Kumar, Ashish, Doshi, Rajkumar, Shah, Palak, Mehran, Roxana, Reed, Grant W., Puri, Rishi, Kapadia, Samir R., Bangalore, Sripal, Kalra, Ankur
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9238658/
https://www.ncbi.nlm.nih.gov/pubmed/35713283
http://dx.doi.org/10.1161/JAHA.121.025205
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author Majmundar, Monil
Ibarra, Gabriel
Kumar, Ashish
Doshi, Rajkumar
Shah, Palak
Mehran, Roxana
Reed, Grant W.
Puri, Rishi
Kapadia, Samir R.
Bangalore, Sripal
Kalra, Ankur
author_facet Majmundar, Monil
Ibarra, Gabriel
Kumar, Ashish
Doshi, Rajkumar
Shah, Palak
Mehran, Roxana
Reed, Grant W.
Puri, Rishi
Kapadia, Samir R.
Bangalore, Sripal
Kalra, Ankur
author_sort Majmundar, Monil
collection PubMed
description BACKGROUND: The role of invasive management compared with medical management in patients with non–ST‐segment–elevation myocardial infarction (NSTEMI) and advanced chronic kidney disease (CKD) is uncertain, given the increased risk of procedural complications in patients with CKD. We aimed to compare clinical outcomes of invasive management with medical management in patients with NSTEMI‐CKD. METHODS AND RESULTS: We identified NSTEMI and CKD stages 3, 4, 5, and end‐stage renal disease admissions using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‐10‐CM) codes from the Nationwide Readmission Database 2016 to 2018. Patients were stratified into invasive and medical management. Primary outcome was mortality (in‐hospital and 6 months after discharge). Secondary outcomes were in‐hospital postprocedural complications (acute kidney injury requiring dialysis, major bleeding) and postdischarge 6‐month safety and major adverse cardiovascular events. Out of 141 052 patients with NSTEMI‐CKD, 85 875 (60.9%) were treated with invasive management, whereas 55 177 (39.1%) patients were managed medically. In propensity‐score matched cohorts, invasive strategy was associated with lower in‐hospital (CKD 3: odds ratio [OR], 0.47 [95% CI, 0.43–0.51]; P<0.001; CKD 4: OR, 0.79 [95% CI, 0.69–0.89]; P<0.001; CKD 5: OR, 0.72 [95% CI, 0.49–1.06]; P=0.096; end‐stage renal disease: OR, 0.51 [95% CI, 0.46–0.56]; P<0.001) and 6‐month mortality. Invasive management was associated with higher in‐hospital postprocedural complications but no difference in postdischarge safety outcomes. Invasive management was associated with a lower hazard of major adverse cardiovascular events at 6 months in all CKD groups compared with medical management. CONCLUSIONS: Invasive management was associated with lower mortality and major adverse cardiovascular events but minimal increased in‐hospital complications in patients with NSTEMI‐CKD compared with medical management, suggesting patients with NSTEMI‐CKD should be offered invasive management.
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spelling pubmed-92386582022-06-30 Invasive Versus Medical Management in Patients With Chronic Kidney Disease and Non–ST‐Segment–Elevation Myocardial Infarction Majmundar, Monil Ibarra, Gabriel Kumar, Ashish Doshi, Rajkumar Shah, Palak Mehran, Roxana Reed, Grant W. Puri, Rishi Kapadia, Samir R. Bangalore, Sripal Kalra, Ankur J Am Heart Assoc Original Research BACKGROUND: The role of invasive management compared with medical management in patients with non–ST‐segment–elevation myocardial infarction (NSTEMI) and advanced chronic kidney disease (CKD) is uncertain, given the increased risk of procedural complications in patients with CKD. We aimed to compare clinical outcomes of invasive management with medical management in patients with NSTEMI‐CKD. METHODS AND RESULTS: We identified NSTEMI and CKD stages 3, 4, 5, and end‐stage renal disease admissions using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‐10‐CM) codes from the Nationwide Readmission Database 2016 to 2018. Patients were stratified into invasive and medical management. Primary outcome was mortality (in‐hospital and 6 months after discharge). Secondary outcomes were in‐hospital postprocedural complications (acute kidney injury requiring dialysis, major bleeding) and postdischarge 6‐month safety and major adverse cardiovascular events. Out of 141 052 patients with NSTEMI‐CKD, 85 875 (60.9%) were treated with invasive management, whereas 55 177 (39.1%) patients were managed medically. In propensity‐score matched cohorts, invasive strategy was associated with lower in‐hospital (CKD 3: odds ratio [OR], 0.47 [95% CI, 0.43–0.51]; P<0.001; CKD 4: OR, 0.79 [95% CI, 0.69–0.89]; P<0.001; CKD 5: OR, 0.72 [95% CI, 0.49–1.06]; P=0.096; end‐stage renal disease: OR, 0.51 [95% CI, 0.46–0.56]; P<0.001) and 6‐month mortality. Invasive management was associated with higher in‐hospital postprocedural complications but no difference in postdischarge safety outcomes. Invasive management was associated with a lower hazard of major adverse cardiovascular events at 6 months in all CKD groups compared with medical management. CONCLUSIONS: Invasive management was associated with lower mortality and major adverse cardiovascular events but minimal increased in‐hospital complications in patients with NSTEMI‐CKD compared with medical management, suggesting patients with NSTEMI‐CKD should be offered invasive management. John Wiley and Sons Inc. 2022-06-17 /pmc/articles/PMC9238658/ /pubmed/35713283 http://dx.doi.org/10.1161/JAHA.121.025205 Text en © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Majmundar, Monil
Ibarra, Gabriel
Kumar, Ashish
Doshi, Rajkumar
Shah, Palak
Mehran, Roxana
Reed, Grant W.
Puri, Rishi
Kapadia, Samir R.
Bangalore, Sripal
Kalra, Ankur
Invasive Versus Medical Management in Patients With Chronic Kidney Disease and Non–ST‐Segment–Elevation Myocardial Infarction
title Invasive Versus Medical Management in Patients With Chronic Kidney Disease and Non–ST‐Segment–Elevation Myocardial Infarction
title_full Invasive Versus Medical Management in Patients With Chronic Kidney Disease and Non–ST‐Segment–Elevation Myocardial Infarction
title_fullStr Invasive Versus Medical Management in Patients With Chronic Kidney Disease and Non–ST‐Segment–Elevation Myocardial Infarction
title_full_unstemmed Invasive Versus Medical Management in Patients With Chronic Kidney Disease and Non–ST‐Segment–Elevation Myocardial Infarction
title_short Invasive Versus Medical Management in Patients With Chronic Kidney Disease and Non–ST‐Segment–Elevation Myocardial Infarction
title_sort invasive versus medical management in patients with chronic kidney disease and non–st‐segment–elevation myocardial infarction
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9238658/
https://www.ncbi.nlm.nih.gov/pubmed/35713283
http://dx.doi.org/10.1161/JAHA.121.025205
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