Temporal Trends in Invasive Management and In-Hospital Mortality of Patients With Non-ST Elevation Acute Coronary Syndromes and Chronic Kidney Disease.
Leonardo De LucaGiuseppe Di PasqualeLucio GonziniMassimo UguccioniZoran OlivariGianni CasellaAlessandro BoccanelliStefano De ServiStefano UrbinatiFurio ColivicchiDomenico GabrielliStefano SavonittoPublished in: Angiology (2020)
We analyzed data from 4 nationwide prospective registries of consecutive patients with acute coronary syndromes (ACS) admitted to the Italian Intensive Cardiac Care Unit network between 2005 and 2014. Out of 26 315 patients with ACS enrolled, 13 073 (49.7%) presented a diagnosis of non-ST elevation (NSTE)-ACS and had creatinine levels available at hospital admission: 1207 (9.2%) had severe chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR] <30), 3803 (29.1%) mild to moderate CKD (eGFR 31-59), and 8063 (61.7%) no CKD (eGFR > 60 mL/min/1.73 m2). Patients with severe CKD had worse clinical characteristics compared with those with mild-moderate or no kidney dysfunction, including all the key predictors of mortality (P < .0001) which became worse over time (all P < .0001). Over the decade of observation, a significant increase in percutaneous coronary intervention rates was observed in patients without CKD (P for trend = .0001), but not in those with any level of CKD. After corrections for significant mortality predictors, severe CKD (odds ratio, OR: 5.49; 95% CI: 3.24-9.29; P < .0001) and mild-moderate CKD (OR: 2.33; 95% CI: 1.52-3.59; P < .0001) remained strongly associated with higher in-hospital mortality. The clinical characteristics of patients with NSTE-ACS and CKD remain challenging and their mortality rate is still higher compared with patients without CKD.
Keyphrases
- chronic kidney disease
- end stage renal disease
- acute coronary syndrome
- percutaneous coronary intervention
- small cell lung cancer
- healthcare
- emergency department
- epidermal growth factor receptor
- antiplatelet therapy
- cardiovascular disease
- ejection fraction
- palliative care
- st segment elevation myocardial infarction
- peritoneal dialysis
- tyrosine kinase
- high intensity
- coronary artery disease
- oxidative stress
- machine learning
- prognostic factors
- patient reported outcomes
- drug induced
- chronic pain
- left ventricular
- uric acid
- cross sectional
- deep learning
- big data
- data analysis
- health insurance
- affordable care act