Management of NonST-segment elevation acute myocardial infarction in patients with chronic kidney disease (from the Korea Acute Myocardial Infarction Registry)

Daisuke Hachinohe, Myung Ho Jeong, Shigeru Saito, Khurshid Ahmed, Seung Hwan Hwang, Min Goo Lee, Doo Sun Sim, Keun Ho Park, Ju Han Kim, Young Joon Hong, Youngkeun Ahn, Jung Chaee Kang, Jong Hyun Kim, Shung Chull Chae, Young Jo Kim, Seung Ho Hur, In Whan Seong, Taek Jong Hong, Donghoon Choi, Myeong Chan ChoChong Jin Kim, Ki Bae Seung, Wook Sung Chung, Yang Soo Jang, Seung Woon Rha, Jang Ho Bae, Seung Jung Park

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19 Citations (Scopus)

Abstract

The aim of this study was to compare clinical outcomes among early invasive (EI), deferred invasive (DI), and conservative strategies in patients with acute nonST-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.

Original languageEnglish
Pages (from-to)206-213
Number of pages8
JournalAmerican Journal of Cardiology
Volume108
Issue number2
DOIs
Publication statusPublished - 2011 Jul 15

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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    Hachinohe, D., Jeong, M. H., Saito, S., Ahmed, K., Hwang, S. H., Lee, M. G., Sim, D. S., Park, K. H., Kim, J. H., Hong, Y. J., Ahn, Y., Kang, J. C., Kim, J. H., Chae, S. C., Kim, Y. J., Hur, S. H., Seong, I. W., Hong, T. J., Choi, D., ... Park, S. J. (2011). Management of NonST-segment elevation acute myocardial infarction in patients with chronic kidney disease (from the Korea Acute Myocardial Infarction Registry). American Journal of Cardiology, 108(2), 206-213. https://doi.org/10.1016/j.amjcard.2011.03.025