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Routine invasive strategy in acute coronary syndrome patients with renal dysfunction. Results of the ARIAM-SEMICYUC registry.
- Source :
-
Medicina intensiva [Med Intensiva] 2016 Jun-Jul; Vol. 40 (5), pp. 280-8. Date of Electronic Publication: 2016 Jan 14. - Publication Year :
- 2016
-
Abstract
- Objective: 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.<br />Methods: A retrospective cohort study based on the ARIAM-SEMICYUC Registry (2011-2014) was carried out. Renal dysfunction was defined as GFR (Cockroft-Gault)<60ml/min (moderate dysfunction) or<30ml/min (severe dysfunction). Patients in which early angiography (<72h) 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.<br />Results: A total of 4,279 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 to 0.81) and 0.52 (95%CI 0.32 to 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).<br />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.<br /> (Copyright © 2015 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.)
- Subjects :
- Acute Coronary Syndrome complications
Acute Coronary Syndrome diagnostic imaging
Aged
Aged, 80 and over
Female
Hospital Mortality
Humans
Intensive Care Units statistics & numerical data
Male
Middle Aged
Non-ST Elevated Myocardial Infarction complications
Non-ST Elevated Myocardial Infarction diagnostic imaging
Propensity Score
Recurrence
Registries
Retrospective Studies
Risk
Severity of Illness Index
Spain epidemiology
Treatment Outcome
Acute Coronary Syndrome therapy
Coronary Angiography
Kidney Diseases complications
Myocardial Revascularization
Non-ST Elevated Myocardial Infarction therapy
Subjects
Details
- Language :
- English; Spanish; Castilian
- ISSN :
- 1578-6749
- Volume :
- 40
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Medicina intensiva
- Publication Type :
- Academic Journal
- Accession number :
- 26777736
- Full Text :
- https://doi.org/10.1016/j.medin.2015.09.008