A study published in the July issue of the American Heart Journal found that in non-revascularized patients with non-ST-elevation myocardial infarction (NSTEMI) found to have coronary artery disease (CAD) on coronary angiography constitute a high-risk subset with a high comorbidity burden. In addition, the presence of chronic kidney disease (CKD) is associated with a higher prevalence of comorbidities, an increase in mortality and major bleeding, and lower use of evidence-based drug therapy.

 

According to the authors, the characteristics and outcomes of the approximately 25 to 35 percent of patients with high-risk acute coronary syndrome who are managed invasively but do not undergo revascularization have not been extensively evaluated. Using data from the Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines (ACTION Registry®-GWTG™), part of the National Cardiovascular Data Registry (NCDR®), the authors aimed to determine "the characteristics and in-hospital outcomes of patients with NSTEMI who underwent an invasive strategy and were found to have significant CAD yet did not undergo any revascularization."

Additional Resources CardioSmart Resources: CKD Fact Sheets

The study looked at 13,872 NSTEMI patients who were then divided into four groups based on their baseline renal function: 1) no CKD, 2) stage three CKD, 3) stage four CKD and 4) stage five CKD. Of this patient population, more than half (55.8 percent) did not have CKD, more than a third (34.8 percent) had CKD stage three, 4.8 percent had CKD stage four and 4.7 percent had CKD stage five.

Results showed that patients with progressively more advanced CKD had more three-vessel CAD and left main disease than patients without CKD. Patients with CAD who did not undergo revascularization had an in-hospital mortality rate of nearly four percent and their in-hospital major bleeding rate approached 11 percent. Stage four CKD patients had the highest proportions of in-hospital mortality and major bleeding, even more severe than stage five patients. However, there was a lower incidence of statins and antiplatelet and anticoagulant therapies administered within 24 hours of hospital readmission for patients with CKD.

The authors conclude that there is a high in-hospital mortality rate in nonrevascularized patients, and that "non-revascularized patients with CKD have more comorbidities than patients without CKD and less frequently receive guideline-recommended therapies." Additionally, CKD was found to be "strongly associated with in-hospital mortality and bleeding."

< Back to Listings