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Minerva Cardiology and Angiology 2023 February;71(1):44-50

DOI: 10.23736/S2724-5683.21.05839-7


language: English

Non-ST-elevation acute coronary syndrome in chronic kidney disease: prognostic implication of an early invasive strategy

Alice SACCO 1 , Claudio MONTALTO 2, Francesca BRAVI 3, Giacomo RUZZENENTI 1, Laura GARATTI 1, Jacopo A. OREGLIA 4, Antonio L. BARTORELLI 5, Gabriele CRIMI 6, Carlo LA VECCHIA 7, Stefano SAVONITTO 8, Sergio LEONARDI 2, Fabrizio G. OLIVA 1, Nuccia MORICI 1, 3

1 Intensive Cardiac Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; 2 University of Pavia and Coronary Care Unit, IRCCS San Matteo Polyclinic Foundation, Pavia, Italy; 3 Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; 4 Interventional Cardiology Division, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; 5 Centro Cardiologico Monzino IRCCS, Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy; 6 Division of Cardiology, San Martino Hospital, Genoa, Italy; 7 Division of Cardiology, Manzoni Hospital, Lecco, Italy

BACKGROUND: The optimal timing of PCI for NSTE-ACS with CKD is unclear. The aim of our study was to assess whether early percutaneous coronary intervention (PCI) (within 24 hours from admission) is associated with improved in-hospital (mortality or acute kidney injury) and long-term events (composite of mortality, myocardial infarction, stroke and bleeding events) in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) with chronic kidney disease (CKD).
METHODS: We retrospectively studied NSTE-ACS patients who underwent PCI in large tertiary centers. CKD was defined as estimated glomerular filtration rate (eGFR)<60 mL/min/1.73 m2. A propensity score for the likelihood of an early invasive strategy was calculated. Relative risks (RR) and adjusted hazard ratios (HR) were estimated for in-hospital and follow-up events.
RESULTS: We included 821 patients, mean age was 69±12 years; 492 (60%) received an early PCI, and 273 (33%) had an eGFR <60. Median follow-up was 391 days. At univariate analysis, early treatment was associated with significantly lower in-hospital and follow-up events. However, after adjustment for major prognostic factors, there was no significant association with both in-hospital (RR=1.06; 95% CI 0.83-1.36) and follow-up events (RR=1.07; 95% CI 0.83-1.37). When the association was assessed in strata of CKD, lack of statistically significant association was confirmed, even if a trend emerged in patients with preserved renal function both on primary outcome (RR=0.47, 95% 0.18-1.22) and time to secondary outcome (HR=0.62, 95% CI 0.36-1.08).
CONCLUSIONS: In conclusion in a cohort of NSTE-ACS patients, an early invasive strategy does not independently affect prognosis.

KEY WORDS: Coronary disease; Comorbidity; Percutaneous coronary intervention; prognosis

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