Renal function and long term mortality after unstable angina/non-ST segment elevation myocardial infarction treated
C Mueller1, F-J Neumann, A P Perruchoud
1Herz-Zentrum, Bad Krozingen, Germany. chmueller@uhbs.ch
Insights
Reduced kidney function significantly increases mortality risk in unstable angina/non-ST elevation acute myocardial infarction (UA/NSTEMI) patients undergoing early invasive treatment. This highlights the importance of assessing renal function for better patient outcomes.
Area of Science:
- Cardiology
- Nephrology
- Clinical Medicine
Background:
- Unstable angina/non-ST elevation acute myocardial infarction (UA/NSTEMI) is a critical cardiovascular condition.
- Early invasive strategies, including coronary angiography and stenting, are standard treatments for UA/NSTEMI.
- The influence of baseline renal function on outcomes in these patients requires further quantification.
Purpose of the Study:
- To determine the impact of baseline renal function on in-hospital and long-term mortality.
- To investigate mortality in UA/NSTEMI patients treated with a very early invasive strategy.
- To stratify mortality risk based on calculated glomerular filtration rate (GFR).
Main Methods:
- Prospective cohort study of 1400 UA/NSTEMI patients.
- Coronary angiography and primary stenting within 24 hours of admission.
- Stratification of patients based on admission calculated glomerular filtration rate (GFR).
Main Results:
- In-hospital mortality rates increased with declining GFR (0% for GFR >130 to 5.1% for GFR <60 ml/min/1.73 m2).
- Three-year survival rates were significantly lower for patients with GFR <60 ml/min/1.73 m2 (76.8%).
- A GFR <60 ml/min/1.73 m2 was a fourfold independent predictor of in-hospital and long-term mortality.
Conclusions:
- Baseline renal function is a critical independent predictor of mortality in UA/NSTEMI patients.
- Early invasive treatment strategies do not negate the prognostic importance of renal function.
- Assessing GFR is crucial for risk stratification and management of UA/NSTEMI patients.
Objectives:
To quantify the impact of baseline renal function on in-hospital and long term mortality in patients with unstable angina/non-ST elevation acute myocardial infarction (UA/NSTEMI) treated with a very early invasive strategy.
Design:
Prospective cohort study of 1400 consecutive patients with UA/NSTEMI undergoing coronary angiography and subsequent coronary stenting of the culprit lesion as the primary revascularisation strategy within 24 hours of admission. Patients were stratified according to calculated glomerular filtration rate (GFR) on admission.
Results:
In-hospital mortality was 0% among patients with a GFR > or = 130 ml/min/1.73 m2, 0.4% with a GFR of 90-129 ml/min/1.73 m2, 2.6% with a GFR of 60-89 ml/min/1.73m2, and 5.1% with a GFR of < 60 ml/min/1.73 m2. Cumulative three year survival rates were 92.6%, 95.5%, 91.9%, and 76.8%, respectively. Patients with a GFR of < 60 ml/min/1.73 m2 were four times more likely to die in hospital (hazard ratio (HR) 4.0, 95% confidence interval (CI) 1.8 to 9.1; p = 0.001) and four times more likely to die during long term follow up (HR 4.0, 95% CI 2.5 to 6.4; p < 0.001). After adjusting for potential confounders, a GFR of < 60 ml/min/1.73 m2 remained a strong independent predictor of long term mortality (HR 2.6, 95% CI 1.5 to 4.5; p = 0.001).
Conclusions:
Baseline renal function is a strong independent predictor of in-hospital and long term mortality after UA/NSTEMI treated with very early revascularisation.
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