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Outcome of Percutaneous Coronary Intervention During Non-ST-Segment-Elevation Myocardial Infarction in Elderly Patients With Chronic Kidney Disease.
J Am Heart Assoc. 2020 Jun 10;:15084
Authors: Holzmann MJ, Siddiqui AJ
Abstract
Background There is a paucity of data on the benefit of revascularization by percutaneous coronary intervention (PCI) during non-ST-segment-elevation myocardial infarction in patients aged >80 years with concurrent chronic kidney disease. Methods and Results Patients aged >80 years with chronic kidney disease, defined as an estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m2 with non-ST-segment-elevation myocardial infarction, during 2011 to 2014 in Sweden retrieved from the SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) Registry. Cox regression was used to estimate adjusted hazard ratios with 95% CIs for all-cause mortality in patients with PCI versus no PCI treatment, stratified for eGFR. Logistic regression was used to evaluate adjusted odds for reinfarction and bleeding during hospitalization. Propensity score weighting analysis was also done as sensitivity analysis. In total, 12 821 patients were included, of whom 47%, 45%, and 8% had an eGFR of >60, 30 to 60, and 15 to <30 mL/min per 1.73 m2, respectively. Patients with eGFR 30 to 60 and 15 to <30 mL/min per 1.73 m2, 22%, and 10%, respectively, underwent PCI, compared with 36% among patients with eGFR >60 mL/min per 1.73 m2. During a mean follow-up of 3.2 years, the absolute risk of death was 42%, 56%, and 76% in patients with eGFR >60, 30 to 60, and 15 to <30 mL/min per 1.73 m2, respectively. Patients who underwent PCI had a lower risk of death in all groups of eGFR (0.47 [95% CI, 0.42-0.53], 0.50 [95% CI, 0.45-0.56], and 0.44 [95% CI, 0.33-0.59], respectively). Patients with eGFR 15 to <30 mL/min per 1.73 m2 had a higher risk of bleeding with PCI. Propensity score weighting showed similar outcomes for mortality risk as the unweighted analysis in all the eGFR groups. Conclusions PCI is rarely used in non-ST-segment-elevation myocardial infarction elderly patients with chronic kidney disease, and it appears to offer a survival benefit.
PMID: 32519559 [PubMed - as supplied by publisher]