Characteristics and In-Hospital Outcomes of Patients Presenting With Non–ST-Segment Elevation Myocardial Infarction Found to Have Significant Coronary Artery Disease on Coronary Angiography and Managed Medically: Stratification According to Renal Function

Study Questions:

What are the characteristics and in-hospital outcomes of patients with non–ST-segment elevation myocardial infarction (NSTEMI) who underwent an invasive strategy and were found to have significant coronary artery disease, yet did not undergo any revascularization?

Methods:

The investigators examined data on 13,872 NSTEMI nonrevascularized patients who were captured by the Acute Coronary Treatment and Intervention Outcomes Network registry. Patients were divided according to baseline renal function in four groups: no chronic kidney disease (CKD) and CKD stages 3, 4, and 5. To evaluate the relationship between in-hospital outcomes and CKD stages, logistic generalized estimating equations method with exchangeable working correlation matrix was used.

Results:

The in-hospital mortality of nonrevascularized patients was 3.7%, whereas their in-hospital major bleeding rate was 10.8%. Overall, 44.2% (n = 6,132) of nonrevascularized patients had CKD. Compared with patients with normal renal function, nonrevascularized patients with CKD had significantly more history of MI, heart failure, more three-vessel coronary artery disease, and received fewer antithrombotic therapies. In addition, they had significantly higher rates of in-hospital mortality and major bleeding; CKD stage 4 was associated with the highest risk of adverse events. The multivariable-adjusted odds ratios of in-hospital mortality for CKD stages 3, 4, and 5 relative to no CKD were 1.5, 2.5, and 2.2, respectively (global p < 0.0001), and the analogous adjusted odds ratios of major bleeding were 1.5, 2.5, and 1.8 (global p < 0.0001).

Conclusions:

The authors concluded that nonrevascularized patients have high in-hospital mortality.

Perspective:

This study reports that patients who present with NSTEMI and are found to have coronary artery disease on coronary angiography yet do not get revascularized constitute a high-risk subset with a high comorbidity burden. The presence of CKD is associated with an even higher prevalence of comorbidities, a further increase in mortality, and major bleeding risk, yet a lower use of evidence-based drug therapy. These high-risk nonrevascularized patients and particularly those with CKD should be targeted for aggressive risk factor modification and optimal use of evidence-based therapies.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Coronary Artery Disease, Myocardial Infarction, Hospital Mortality, Coronary Angiography


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