Routine invasive strategy in acute coronary syndrome patients with renal dysfunction. Results of the ARIAM-SEMICYUC registry

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• 作者：J. Latour-P&eacute ; rez^a ; ^{jlatour@coma.es" class="auth_mail" title="E-mail the corresponding author} ; V. G&oacute ; mez-Tello^b ; E. de-Miguel-Balsa^a ; A. Llamas-&Aacute ; lvarez^a ; A. Carrillo-L&oacute ; pez^c ; J.A. S&aacute ; nchez-Rom&aacute ; n^d ; J. Ru&iacute ; z-Ru&iacute ; z^e ; M.C. Mart&iacute ; n-Rodr&iacute ; guez^f ; C.J. Fern&aacute ; ndez-Gonz&aacute ; lez^g ; J.A. Fern&aacute ; ndez-Lozano^h ; C. Picazos Vicente^a ; Grupo ARIAM-SEMICYUC^&loz ;
• 关键词：Percutaneous coronary intervention ; Acute coronary syndrome ; Renal dysfunction ; Mortality ; Registries
• 刊名：Medicina Intensiva (English Edition)
• 出版年：2016
• 出版时间：June-July 2016
• 年：2016
• 卷：40
• 期：5
• 页码：280-288
• 全文大小：855 K

文摘

To evaluate the use and effectiveness of a routine invasive strategy (RIS) in patients with acute coronary syndrome without persistent ST-segment elevation with renal dysfunction in the real world scenario.

Methods

A retrospective cohort study based on the ARIAM-SEMICYUC Registry (2011–2014) was carried out. Renal dysfunction was defined as GFR (Cockroft–Gault) <60 ml/min (moderate dysfunction) or <30 ml/min (severe dysfunction). Patients in which early angiography (<72 h) was performed due to cardiogenic shock or recurrent myocardial ischemia were excluded. The primary endpoint was hospital mortality. Confounding factors were controlled using propensity score analysis.

Results

A total of 4279 patients were analyzed, of which 26% had moderate renal dysfunction and 5% severe dysfunction. Patients with renal dysfunction had greater severity and comorbidity, higher hospital mortality (8.6 vs. 1.8%), and lesser use of the RIS (40 vs. 52%). The adjusted OR for mortality in patients without/with renal dysfunction were 0.38 (95% confidence interval [95%CI] 0.17–0.81) and 0.52 (95%CI 0.32–0.87), respectively (interaction p-value = .4779). The impact (adjusted risk difference) of RIS was higher in the group with renal dysfunction (−5.1%, 95%CI −8.1 to −2.1 vs. −1.6%, 95%CI −2.6 to −0.6; interaction p-value = .0335). No significant interaction was detected for the other endpoints considered (ICU mortality, 30-day mortality, myocardial infarction, acute renal failure or moderate/severe bleeding).

Conclusions

The results suggest that the effectiveness of IRS is similar in patients with normal or abnormal renal function, and alert to the under-utilization of this strategy in such patients.