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

Yong Hoon Kim1, Ae-Young Her1, Seung-Woon Rha2

  • 1Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Chuncheon, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Republic of Korea.

JACC. Asia
|August 1, 2026
PubMed

Insights

Percutaneous coronary intervention (PCI) in non-ST-segment elevation myocardial infarction (NSTEMI) with impaired renal function is linked to better outcomes. PCI showed reduced risks for major adverse cardiac and cerebrovascular events across most renal function groups, except for those with optimal kidney function.

Area of Science:

  • Cardiology
  • Nephrology
  • Interventional Cardiology

Background:

  • Renal dysfunction is a known risk factor for 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 renal function in NSTEMI patients.

Purpose of the Study:

  • To compare the 3-year outcomes of PCI versus non-PCI in NSTEMI patients stratified by baseline renal function.
  • To evaluate the impact of renal function on the effectiveness of PCI in NSTEMI.

Main Methods:

  • A cohort of 15,255 NSTEMI patients was stratified by estimated glomerular filtration rate (eGFR) into four groups: ≥90, 60-89, 30-59, and <30 mL/min/1.73 m².
  • The primary outcome was the composite of major adverse cardiac and cerebrovascular events (MACCE) at 3 years, including all-cause death, recurrent myocardial infarction, or stroke.
  • Multivariable-adjusted Cox regression analysis was used to assess 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 eGFR ≥90 mL/min/1.73 m² (HR: 0.83 [95% CI: 0.64-1.07]; P = 0.158).

Conclusions:

  • In NSTEMI patients, declining renal function is associated with higher long-term adverse cardiovascular outcomes.
  • PCI demonstrates a reduced risk of adverse events across most strata of renal function in NSTEMI, highlighting its benefit in patients with moderate to severe kidney impairment.
  • The benefit of PCI was not evident in NSTEMI patients with optimal renal function (eGFR ≥90 mL/min/1.73 m²).
Abstract

Keywords:
glomerular filtration ratemyocardial infarctionnon–ST-segment elevationtreatment outcome

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