Patients with severe chronic kidney disease benefit from early revascularization after acute coronary syndrome

Henry D. Huang, Mahboob Alam, Ihab Hamzeh, Salim Virani, Anita Deswal, David Aguilar, Paul Rogers, Panos Kougias, Yochai Birnbaum, David Paniagua, Biswajit Kar, Christie Ballantyne, Biykem Bozkurt, Hani Jneid

Research output: Contribution to journalArticlepeer-review

50 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)3741-3746
Number of pages6
JournalInternational Journal of Cardiology
Volume168
Issue number4
DOIs
Publication statusPublished - 9 Oct 2013
Externally publishedYes

Keywords

  • Acute coronary syndrome
  • Chronic kidney disease
  • Coronary artery disease
  • Early invasive strategy
  • Myocardial infarction
  • Revascularization

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