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Comparative Study
. 2018 Mar 10;7(6):e007920.
doi: 10.1161/JAHA.117.007920.

Non-ST-Segment-Elevation Myocardial Infarction Among Patients With Chronic Kidney Disease: A Propensity Score-Matched Comparison of Percutaneous Coronary Intervention Versus Conservative Management

Subir Bhatia  1 , Shilpkumar Arora  2 , Sravya M Bhatia  3 , Mohammed Al-Hijji  4 , Yogesh N V Reddy  4 , Parshva Patel  5 , Charanjit S Rihal  4 , Bernard J Gersh  4 , Abhishek Deshmukh  6
Affiliations
Comparative Study

Non-ST-Segment-Elevation Myocardial Infarction Among Patients With Chronic Kidney Disease: A Propensity Score-Matched Comparison of Percutaneous Coronary Intervention Versus Conservative Management

Subir Bhatia et al. J Am Heart Assoc. .

Abstract

Background: Chronic kidney disease (CKD) remains an independent predictor of cardiovascular morbidity and mortality. CKD complicates referral for percutaneous coronary intervention (PCI) in non-ST-segment-elevation myocardial infarction (NSTEMI) patients because of the risk for acute kidney injury and the need for dialysis, with American College of Cardiology/American Heart Association guidelines underscoring the limited data on these patients.

Methods and results: Using the National Inpatient Sample to analyze hospitalizations in the United States from 2004 to 2014, we sought to assess PCI utilization and in-hospital outcomes in NSTEMI admissions with CKD. NSTEMI admissions were identified by International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) code 410.7. CKD admissions were identified by ICD-9-CM code 585. Propensity score-matched cohorts of patients with NSTEMI were matched for age, sex, comorbidities, race, median household income, primary payer status, and hospital characteristics. Of 4 488 795 hospitalizations for NSTEMI, 31% underwent PCI. Overall, 89% of admissions had no CKD. In addition, 32% of NSTEMI admissions with no CKD and 23%, 14%, and 22% with CKD stages 3, 4, and 5 underwent PCI, respectively. Hospitalized NSTEMI patients with CKD stages 4 and 5 had 41% and 20% less likelihood, respectively, of undergoing PCI compared with those with no CKD. Among hospitalized NSTEMI patients with no CKD or CKD stage 3, 4, or 5, PCI-treated groups had 63%, 57%, 39%, and 59% lower likelihood, respectively, of all-cause, in-hospital mortality compared with propensity score-matched medically managed groups.

Conclusions: PCI use decreased among hospitalized NSTEMI patients as CKD severity increased, and all-cause, in-hospital mortality was greater for NSTEMI patients admitted with more severe CKD regardless of treatment strategy.

Keywords: acute coronary syndrome; chronic kidney disease.

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Figures

Figure 1
Figure 1
All‐cause, in‐hospital mortality of non–ST‐segment–elevation myocardial infarction patients by CKD status in propensity score‐–matched groups. CKD indicates chronic kidney disease; ESRD, end‐stage renal disease; HD, hemodialysis; PCI, percutaneous coronary intervention.
Figure 2
Figure 2
AKI needing dialysis based on CKD stage. AKI indicates acute kidney injury; CKD, chronic kidney disease; PCI, percutaneous coronary intervention.
See this image and copyright information in PMC

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