TY - JOUR
T1 - Patients with severe chronic kidney disease benefit from early revascularization after acute coronary syndrome
AU - Huang, Henry D.
AU - Alam, Mahboob
AU - Hamzeh, Ihab
AU - Virani, Salim
AU - Deswal, Anita
AU - Aguilar, David
AU - Rogers, Paul
AU - Kougias, Panos
AU - Birnbaum, Yochai
AU - Paniagua, David
AU - Kar, Biswajit
AU - Ballantyne, Christie
AU - Bozkurt, Biykem
AU - Jneid, Hani
PY - 2013/10/9
Y1 - 2013/10/9
N2 - Background Early revascularization is associated with improved outcomes after non-ST-elevation acute coronary syndrome (ACS). It is unclear whether its benefits exist in patients with ACS and advanced chronic kidney disease (CKD), because these patients are often sub-optimally treated and excluded from clinical trials. Methods We undertook meta-analyses of short- and long-term mortality outcomes in comparative studies examining the effectiveness of early revascularization in patients with ACS and CKD (as estimated by Glomerular Filtration Rate, eGFR). A literature search between 1995 and 2010 identified 7 published reports enrolling 23,234 patients with at least mild reduction in eGFR (< 90 mL/min/1.73 m2), of whom 6276 and 16,958 patients received early revascularization versus initial medical therapy, respectively. Summary odds ratios (OR) and their 95% Confidence Intervals (CIs) were calculated using the random-effects models. Sensitivity analyses were performed by one-study removal, and publication bias was assessed by the funnel plot analysis. Results Early revascularization was associated with a reduction in 1-year mortality compared to initial medical therapy (OR = 0.46, 95% CI 0.26-0.82, P = 0.008) among ACS patients with eGFR < 60 mL/min/1.73 m2. The mortality reduction with early revascularization occurred upfront (short term mortality OR = 0.69, 95% CI 0.56-0.87, P = 0.001), persisted at 3 years (OR = 0.54, 95% CI 0.31-0.96, P = 0.037), was evident across all CKD stages (including dialysis patients), and was independent of the influence of any single study. Conclusions Early revascularization after ACS is associated with reduced mortality in appropriately-selected patients with CKD, including those with severe CKD or receiving dialysis.
AB - Background Early revascularization is associated with improved outcomes after non-ST-elevation acute coronary syndrome (ACS). It is unclear whether its benefits exist in patients with ACS and advanced chronic kidney disease (CKD), because these patients are often sub-optimally treated and excluded from clinical trials. Methods We undertook meta-analyses of short- and long-term mortality outcomes in comparative studies examining the effectiveness of early revascularization in patients with ACS and CKD (as estimated by Glomerular Filtration Rate, eGFR). A literature search between 1995 and 2010 identified 7 published reports enrolling 23,234 patients with at least mild reduction in eGFR (< 90 mL/min/1.73 m2), of whom 6276 and 16,958 patients received early revascularization versus initial medical therapy, respectively. Summary odds ratios (OR) and their 95% Confidence Intervals (CIs) were calculated using the random-effects models. Sensitivity analyses were performed by one-study removal, and publication bias was assessed by the funnel plot analysis. Results Early revascularization was associated with a reduction in 1-year mortality compared to initial medical therapy (OR = 0.46, 95% CI 0.26-0.82, P = 0.008) among ACS patients with eGFR < 60 mL/min/1.73 m2. The mortality reduction with early revascularization occurred upfront (short term mortality OR = 0.69, 95% CI 0.56-0.87, P = 0.001), persisted at 3 years (OR = 0.54, 95% CI 0.31-0.96, P = 0.037), was evident across all CKD stages (including dialysis patients), and was independent of the influence of any single study. Conclusions Early revascularization after ACS is associated with reduced mortality in appropriately-selected patients with CKD, including those with severe CKD or receiving dialysis.
KW - Acute coronary syndrome
KW - Chronic kidney disease
KW - Coronary artery disease
KW - Early invasive strategy
KW - Myocardial infarction
KW - Revascularization
UR - http://www.scopus.com/inward/record.url?scp=84886240344&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2013.06.013
DO - 10.1016/j.ijcard.2013.06.013
M3 - Article
C2 - 23845772
AN - SCOPUS:84886240344
SN - 0167-5273
VL - 168
SP - 3741
EP - 3746
JO - International Journal of Cardiology
JF - International Journal of Cardiology
IS - 4
ER -