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. 2013 Dec 30;9(6):1019-27.
doi: 10.5114/aoms.2013.39792. Epub 2013 Dec 26.

Treatment of non-ST-elevation myocardial infarction and ST-elevation myocardial infarction in patients with chronic kidney disease

Beata Franczyk-Skóra  1 , Anna Gluba  1 , Maciej Banach  2 , Jacek Rysz  1
Affiliations

Treatment of non-ST-elevation myocardial infarction and ST-elevation myocardial infarction in patients with chronic kidney disease

Beata Franczyk-Skóra et al. Arch Med Sci. .

Abstract

Renal dysfunction is frequent in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Chronic kidney disease (CKD) is associated with very poor prognosis and is an independent predictor of early and late mortality and major bleeding in patients with NSTE-ACS. Patients with NSTE-ACS and CKD are still rarely treated according to guidelines. Medical registers reveal that patients with CKD are usually treated with too high doses of antithrombotics, especially anticoagulants and inhibitors of platelet glycoprotein (GP) IIb/IIIa receptors, and therefore they are more prone to bleeding. Drugs which are excreted mainly or exclusively by the kidney should be administered in a reduced dose or discontinued in patients with CKD. These drugs include enoxaparin, fondaparinux, bivalirudin, and small molecule inhibitors of GP IIb/IIIa inhibitors. In long-term treatment of patients after myocardial infarction, anti-platelet therapy, lipid-lowering therapy and β-blockers are used. Chronic kidney disease patients before qualification for coronary interventions should be carefully selected in order to avoid their use in the group of patients who could not benefit from such procedures. This paper presents schemes of non-ST and ST-segment elevation myocardial infarction treatment in CKD patients in accordance with the current recommendations of the European Society of Cardiology (ESC).

Keywords: bleeding; chronic kidney disease; management; myocardial infarction; treatment.

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Figures

Figure 1
Figure 1
ACS treatment in CKD patients with the division into high and low risk patients according to European Society of Cardiology (ESC) 2011 recommendations *Indicated for people in high risk group
Figure 2
Figure 2
The ESC recommendations concerning ACS management in CKD patients *Enoxoparin is used in conservative theraphy, while unfractioned heparin in early invasive treatment
Figure 3
Figure 3
Schemes of invasive treatment in accordance with recommendations of European Society of Cardiology
See this image and copyright information in PMC

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