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Minerva Cardiology and Angiology 2022 Feb 25

DOI: 10.23736/S2724-5683.21.05839-7


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, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; 3 Department of Clincal Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; 4 Interventional Cardiology Division and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; 5 Centro Cardiologico Monzino, IRCCS, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy; 7 Division of Cardiology, Ospedale San Martino, Genova, Italy; 8 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/1.73m2. 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 followup 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: Acute coronary disease; Comorbidities; Coronary revascularization; Timing; Prognosis

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