Impact of impaired glomerular filtration rate and revascularization strategy on one-year cardiovascular events in acute coronary syndrome: Data from Taiwan acute coronary syndrome full spectrum registry
Journal
BMC Nephrology
Journal Volume
15
Journal Issue
1
Date Issued
2014
Author(s)
Lin T.-H.
Hsin H.-T.
Wang C.-L.
Lai W.-T.
Li A.-H.
Kuo C.-T.
Chang S.-C.
Chang C.-J.
Abstract
Background: The optimal revascularization strategy for patients with impaired glomerular filtration rate (IGFR) has not been established in acute coronary syndrome (ACS). We investigated the prognosis and impact of IGFR and invasive strategy on the cardiovascular outcomes in the ACS population. Methods. In a Taiwan national-wide registry, 3093 ACS patients were enrolled. The invasive strategy was defined as patients with ST-elevation ACS (STE-ACS) undergoing primary angioplasty or fibrinolysis or coronary angiography with intent to revascularization performed within 72 hours of symptom onset in non-ST-elevation ACS (NSTE-ACS). IGFR was defined as an estimated GFR of less than 60 ml/min per 1.73 m2. Primary endpoint was a composite of death, non-fatal myocardial infarction or stroke at one year. Results: Patients with IGFR (n = 1226) had more comorbidities but received less evidence-based medications during admission than those without IGFR (n = 1867). The primary endpoint-free survival rate is lower in the IGFR patients, in the whole, STE-ACS and NSTE-ACS population (all log-rank tests p < 0.01). Cox regression analysis revealed IGFR subjects had higher primary endpoint after adjusting by age, sex, medication at discharge and traditional risk factors (all p < 0.01). Kaplan-Meier curves showed IGFR patients without invasive strategy had the worst outcome in the STE-ACS and NSTE-ACS population (both p < 0.01). The invasive strategies, either with early angiography only or angioplasty, were associated with reduced primary endpoints among IGFR patients in the NSTE-ACS population (both p ≦ 0.024). Conclusions: IGFR patients suffering from ACS had poor prognosis and an invasive strategy could improve cardiovascular outcome in the NSTE-ACS population. ? 2014 Lin et al.; licensee BioMed Central Ltd.
SDGs
Other Subjects
acute coronary syndrome; adult; aged; angiocardiography; article; cardiovascular disease; cardiovascular risk; cerebrovascular accident; comorbidity; female; fibrinolysis; glomerulus filtration rate; heart death; heart infarction; heart muscle revascularization; high risk patient; human; log rank test; major clinical study; male; multicenter study; non ST segment elevation myocardial infarction; outcome assessment; prognosis; proportional hazards model; risk assessment; risk factor; ST segment elevation; survival rate; Taiwan; transluminal coronary angioplasty; acute coronary syndrome; clinical trial; epidemiology; incidence; longitudinal study; mortality; percutaneous coronary intervention; register; Renal Insufficiency, Chronic; treatment outcome; Acute Coronary Syndrome; Causality; Comorbidity; Female; Glomerular Filtration Rate; Humans; Incidence; Longitudinal Studies; Male; Percutaneous Coronary Intervention; Registries; Renal Insufficiency, Chronic; Risk Factors; Survival Rate; Taiwan; Treatment Outcome
Type
journal article