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Invasive Management and Outcomes in Acute Coronary Syndromes and Chronic Kidney Disease (ANZACS-QI 70)

Andrew J Kerr1, Yeunhyang Catherine Choi2, Helen L Pilmore3

  • 1Middlemore Hospital, Auckland, New Zealand; Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand; Department of Medicine, University of Auckland, Auckland, New Zealand.

Heart, Lung & Circulation
|May 25, 2023
PubMed

Insights

Patients with advanced chronic kidney disease (CKD) and acute coronary syndromes (ACS) receive less invasive angiography, despite increased mortality. Further clinical trials are needed to determine optimal management strategies for this high-risk population.

Area of Science:

  • Cardiology
  • Nephrology
  • Public Health

Background:

  • Acute coronary syndromes (ACS) guidelines recommend invasive coronary angiography.
  • Patients with advanced chronic kidney disease (CKD) are often excluded from ACS studies.
  • The utilization and outcomes of coronary angiography in ACS patients with varying stages of CKD are not well-defined.

Purpose of the Study:

  • To describe the incidence of CKD in a comprehensive ACS cohort.
  • To analyze the utilization of coronary angiography based on CKD stage.
  • To evaluate the outcomes of ACS patients according to CKD stage and angiography use.

Main Methods:

  • Utilized national datasets to identify hospitalized ACS patients (2013-2018) in New Zealand.
  • Determined CKD stage using a linked laboratory dataset.
  • Assessed all-cause and cause-specific mortality, myocardial infarction, heart failure, and stroke as outcomes.

Main Results:

  • 38% of 23,432 ACS patients had CKD stage 3 or higher; 10% had stages 4/5 CKD.
  • Coronary angiography rates decreased with increasing CKD severity, except for patients on dialysis.
  • All-cause mortality significantly increased with CKD stage, reaching 69% in stages 4/5 CKD without dialysis.

Conclusions:

  • Invasive management decreased significantly below an eGFR of 45 mL/min (stage 3b CKD).
  • Nearly half of all ACS deaths occurred in patients with advanced CKD.
  • Clinical trials are essential to evaluate the role of invasive management in ACS patients with advanced CKD.
Abstract

Keywords:
Acute coronary syndromesCardiovascular diseaseChronic kidney diseaseCoronary angiographyMortality

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