Prognosis by Renal Function With or Without Percutaneous Coronary Intervention in Non-ST-Segment Elevation Myocardial...

Area of Science:

• Cardiology
• Nephrology
• Clinical Research

Background:

• Renal dysfunction is a known predictor of adverse outcomes in patients with non-ST-segment elevation myocardial infarction (NSTEMI).
• Limited evidence exists comparing percutaneous coronary intervention (PCI) versus non-PCI strategies based on varying degrees of renal function in NSTEMI patients.

Purpose of the Study:

• To evaluate and compare the 3-year clinical outcomes of PCI versus non-PCI in NSTEMI patients stratified by baseline renal function.
• To identify potential benefits or risks associated with PCI across different levels of estimated glomerular filtration rate (eGFR).

Main Methods:

• A cohort of 15,255 NSTEMI patients was analyzed, stratified into four groups based on eGFR (≥90, 60-89, 30-59, and <30 mL/min/1.73 m²).
• The primary endpoint was the incidence of major adverse cardiac and cerebrovascular events (MACCE) at 3 years, defined as all-cause death, recurrent myocardial infarction, or stroke.
• Multivariable-adjusted Cox regression models were used to analyze outcomes, with a median follow-up of 36.0 months.

Main Results:

• Worsening renal function correlated with increased MACCE and mortality, except between eGFR ≥90 and 60-89 mL/min/1.73 m² groups.
• PCI was associated with significantly lower adjusted risks for MACCE, all-cause mortality, and cardiovascular mortality in patients with eGFR 60-89, 30-59, and <30 mL/min/1.73 m².
• No significant benefit of PCI on MACCE was observed in patients with normal renal function (eGFR ≥90 mL/min/1.73 m²).

Conclusions:

• In NSTEMI patients, declining renal function is associated with higher long-term adverse cardiovascular outcomes.
• PCI demonstrates a significant survival and clinical benefit in NSTEMI patients with moderate to severe renal impairment (eGFR <90 mL/min/1.73 m²).
• PCI does not appear to offer a significant advantage for MACCE in NSTEMI patients with preserved renal function (eGFR ≥90 mL/min/1.73 m²).