The aim of this study was to compare clinical outcomes among early invasive (EI),
deferred invasive (DI), and conservative strategies in patients with acute non–ST-segment
elevation myocardial infarction (NSTEMI) and chronic kidney disease (CKD). High-risk
patients with NSTEMI are believed to fare better with an EI strategy, but the optimal
treatment for patients with NSTEMI and CKD is not known. In total 5,185 patients with
acute NSTEMI were enrolled from the Korea Acute Myocardial Infarction Registry and
followed for 1 year. Patients were divided into EI, DI, and conservative treatment
groups and classified into 4 stages using references from the National Kidney Foundation.
The invasive EI and DI groups were compared to the conservative groups, and the EI
and DI groups were compared according to each renal function stage. At 1-year follow-up,
mortality rates in the conservative group were significantly higher than in the invasive
groups except for the severe CKD group. The benefit of the EI over the DI strategy,
although there were no significant differences between the 2 groups, tended to decrease
as renal function decreased. In conclusion, in the management of NSTEMI, an invasive
strategy decreased mortality compared to a conservative strategy except for severe
CKD. In the timing of an invasive strategy, the EI strategy was observed to be superior
to the DI strategy in patients with mild CKD; however, this tendency reversed as renal
function decreased. When patients with NSTEMI have severe CKD, a conservative or DI
strategy with prescription of cardioprotective medications and prevention of further
deterioration in renal function should be considered.
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Article info
Publication history
Accepted:
March 9,
2011
Received in revised form:
March 9,
2011
Received:
January 2,
2011
Footnotes
This study was performed with the support of the Korean Society of Circulation, Seoul, Republic of Korea, in honor of its 50th anniversary and Grant A084869 from the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare & Family Affairs, Seoul, Republic of Korea.
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
