ORIGINAL ARTICLE   

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

DOI: 10.23736/S2724-5683.21.05839-7

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

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