Patients with severe chronic kidney disease benefit from early revascularization after acute coronary syndrome.
Int J Cardiol. 2013 Jul 8;
Authors: Huang HD, Alam M, Hamzeh I, Virani S, Deswal A, Aguilar D, Rogers P, Kougias P, Birnbaum Y, Paniagua D, Kar B, Ballantyne C, Bozkurt B, Jneid H
BACKGROUND: Early revascularization is associated with improved outcomes after non-ST-elevation acute coronary syndrome (ACS). It is unclear whether its benefits exist in patients with ACS and advanced chronic kidney disease (CKD), because these patients are often sub-optimally treated and excluded from clinical trials.
METHODS: We undertook meta-analyses of short- and long-term mortality outcomes in comparative studies examining the effectiveness of early revascularization in patients with ACS and CKD (as estimated by Glomerular Filtration Rate, eGFR). A literature search between 1995 and 2010 identified 7 published reports enrolling 23,234 patients with at least mild reduction in eGFR (<90mL/min/1.73m(2)), of whom 6276 and 16,958 patients received early revascularization versus initial medical therapy, respectively. Summary odds ratios (OR) and their 95% Confidence Intervals (CIs) were calculated using the random-effects models. Sensitivity analyses were performed by one-study removal, and publication bias was assessed by the funnel plot analysis.
RESULTS: Early revascularization was associated with a reduction in 1-year mortality compared to initial medical therapy (OR=0.46, 95% CI 0.26-0.82, P=0.008) among ACS patients with eGFR<60mL/min/1.73m(2). The mortality reduction with early revascularization occurred upfront (short term mortality OR=0.69, 95% CI 0.56-0.87, P=0.001), persisted at 3years (OR=0.54, 95% CI 0.31-0.96, P=0.037), was evident across all CKD stages (including dialysis patients), and was independent of the influence of any single study.
CONCLUSIONS: Early revascularization after ACS is associated with reduced mortality in appropriately-selected patients with CKD, including those with severe CKD or receiving dialysis.
PMID: 23845772 [PubMed - as supplied by publisher]