Management of Non-ST-Segment Elevation Acute Myocardial Infarction in Patients With Chronic Kidney Disease (from the Korea Acute Myocardial Infarction Registry)

Title
Management of Non-ST-Segment Elevation Acute Myocardial Infarction in Patients With Chronic Kidney Disease (from the Korea Acute Myocardial Infarction Registry)
Author(s)
김영조다이스케 하치노헤[다이스케 하치노헤]정명호[정명호]시게루 사이토[시게루 사이토]Khrushid Ahmed[Khrushid Ahmed]황승환[황승환]이민구[이민구]심두선[심두선]박근호[박근호]김주한[김주한]홍영준[홍영준]안영근[안영근]강정채[강정채]김종현[김종현]채성철[채성철]허승호[허승호]성인완[성인완]홍택종[홍택종]최동훈[최동훈]조명찬[조명찬]김종진[김종진]승기배[승기배]정욱성[정욱성]장양수[장양수]라승운[라승운]배장호[배장호]박승정[박승정]
Keywords
ACUTE CORONARY SYNDROMES; RITA-3 RANDOMIZED-TRIAL; GLOBAL REGISTRY; UNSTABLE ANGINA; RENAL-INSUFFICIENCY; INVASIVE MANAGEMENT; ARTERY-DISEASE; OUTCOMES; INTERVENTION; STRATEGY
Issue Date
201107
Publisher
EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
Citation
AMERICAN JOURNAL OF CARDIOLOGY, v.108, no.2, pp.206 - 213
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 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. (C) 2011 Elsevier Inc. All rights reserved. (Am J Cardiol 2011;108:206-213)
URI
http://hdl.handle.net/YU.REPOSITORY/24869http://dx.doi.org/10.1016/j.amjcard.2011.03.025
ISSN
0002-9149
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