Impact of impaired glomerular filtration rate and revascularization strategy on one-year cardiovascular events in acute coronary syndrome: data from Taiwan acute coronary syndrome full spectrum registry

BMC Nephrology

Chee-Jen Chang¹  Shu-Chen Chang⁵  Fu-Tien Chiang²  Juey-Jen Hwang²  Chi-Tai Kuo⁴  Ai-Hsien Li³  Wen-Ter Lai⁶  Chun-Li Wang⁴  Ho-Tsung Hsin³  Tsung-Hsien Lin⁶ 

[1]Graduate Institute of Clinical Medicine, Research Center for Clinical Informatics and Medical Statistics, Chang Gung University, Taoyuan, Taiwan

[2]Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

[3]Division of Cardiology, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan

[4]Division of Cardiology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan

[5]Division of Biostatistics, Institute of Public Health, National Yang-Ming University, Taipei, Taiwan

[6]Department of Internal Medicine, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

关键词: Angiography;    Revascularization;    Invasive;    Chronic kidney disease;    Acute coronary syndrome;   

Others  :  1082695
DOI  :  10.1186/1471-2369-15-66

 received in 2014-01-12, accepted in 2014-04-16,  发布年份 2014

【 摘 要 】

Background

The optimal revascularization strategy for patients with impaired glomerular filtration rate (IGFR) has not been established in acute coronary syndrome (ACS). We investigated the prognosis and impact of IGFR and invasive strategy on the cardiovascular outcomes in the ACS population.

Methods

In a Taiwan national-wide registry, 3093 ACS patients were enrolled. The invasive strategy was defined as patients with ST-elevation ACS (STE-ACS) undergoing primary angioplasty or fibrinolysis or coronary angiography with intent to revascularization performed within 72 hours of symptom onset in non-ST-elevation ACS (NSTE-ACS). IGFR was defined as an estimated GFR of less than 60 ml/min per 1.73 m². Primary endpoint was a composite of death, non-fatal myocardial infarction or stroke at one year.

Results

Patients with IGFR (n = 1226) had more comorbidities but received less evidence-based medications during admission than those without IGFR (n = 1867). The primary endpoint-free survival rate is lower in the IGFR patients, in the whole, STE-ACS and NSTE-ACS population (all log-rank tests p < 0.01). Cox regression analysis revealed IGFR subjects had higher primary endpoint after adjusting by age, sex, medication at discharge and traditional risk factors (all p < 0.01). Kaplan–Meier curves showed IGFR patients without invasive strategy had the worst outcome in the STE-ACS and NSTE-ACS population (both p < 0.01). The invasive strategies, either with early angiography only or angioplasty, were associated with reduced primary endpoints among IGFR patients in the NSTE-ACS population (both p ≦ 0.024).

Conclusions

IGFR patients suffering from ACS had poor prognosis and an invasive strategy could improve cardiovascular outcome in the NSTE-ACS population.

【 授权许可】

   
2014 Lin et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]El Nahas AM, Bello AK: Chronic kidney disease: the global challenge. Lancet 2005, 365:331-340.
• [2]Levey AS, Atkins R, Coresh J, Cohen EP, Collins AJ, Eckardt KU, Nahas ME, Jaber BL, Jadoul M, Levin A, Powe NR, Rossert J, Wheeler DC, Lameire N, Eknoyan G: Chronic kidney disease as a global public health problem: approaches and initiatives – a position statement from kidney disease improving global outcomes. Kidney Int 2007, 72:247-259.
• [3]USRDS: International comparisons. In United Stated Renal Data System Annual Data Report. Bethesda, MD: The National Institute of Health, National Institute of Diabetes and Digestive and Kidney Disease; 2009:344-355.
• [4]Hwang SJ, Tsai JC, Chen HC: Epidemiology, impact and preventive care of chronic kidney disease in Taiwan. Nephrology (Carlton) 2010, (Suppl 2):3-9.
• [5]Schiele F: Renal dysfunction and coronary disease: a high-risk combination. J Nephrol 2009, 22(1):39-45.
• [6]Brosius FC III, Hostetter TH, Kelepouris E, Mitsnefes MM, Moe SM, Moore MA, Pennathur S, Smith GL, Wilson PW, American Heart Association Kidney and Cardiovascular Disease Council; Council on High Blood Pressure Research; Council on Cardiovascular Disease in the Young; Council on Epidemiology and Prevention; Quality of Care and Outcomes Research Interdisciplinary Working Group: Detection of chronic kidney disease in patients with or at increased risk of cardiovascular disease: a science advisory from the American Heart Association Kidney And Cardiovascular Disease Council; the Councils on High Blood Pressure Research, Cardiovascular Disease in the Young, and Epidemiology and Prevention; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: developed in collaboration with the National Kidney Foundation. Circulation 2006, 114(10):1083-1087.
• [7]Rodrigues FB, Bruetto RG, Torres US, Otaviano AP, Zanetta DM, Burdmann EA: Effect of kidney disease on acute coronary syndrome. Clin J Am Soc Nephrol 2010, 5(8):1530-1536.
• [8]Surana SP, Riella LV, Keithi-Reddy SR, Charytan DM, Singh AK: Acute coronary syndrome in ESRD patients. Kidney Int 2009, 75(5):558-562.
• [9]Szummer K, Lundman P, Jacobson SH, Schön S, Lindbäck J, Stenestrand U, Wallentin L, Jernberg T: SWEDEHEART: influence of renal function on the effects of early revascularization in non-ST-elevation myocardial infarction: data from the Swedish web-system for enhancement and development of evidence-based care in heart disease evaluated according to recommended therapies (SWEDEHEART). Circulation 2009, 120:851-858.
• [10]Chiang FT, Kou-Gi Shyu KG, Wu CJ, Mar GY, Hou Charles JY, Li AH, Wen MS, Lai WT, Lin SJ, Kuo CT, Kuo C, Li YH, Hwang JJ: Predictors of 1-year outcomes in the Taiwan acute coronary syndrome full spectrum registry. J Formos Med Assoc 2013. doi: 10.1016/j.jfma.2013.08.001
• [11]Shyu KG, Wu CJ, Mar GY, Hou Charles JY, Li AH, Wen MS, Lai WT, Lin SJ, Kuo CT, Hwang JJ, Chiang FT: Clinical characteristics, management and in-hospital outcomes of patients with acute coronary syndrome - observations from the Taiwan ACS full spectrum registry. Acta Cardiol Sin 2011, 27:135-144.
• [12]International Epidemiological Association guidelineshttp://www.ieaweb.org/index.php?option=com_content&view=article&id=15%3Agoodepidemiological-practice-gep&catid=20%3Agood-epidemiological-practicegep&Itemid=43&limitstart=1 webcite. Accessed 511 28 Jan 2011
• [13]Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF III, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J, CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration): A new equation to estimate glomerular filtration rate. Ann Intern Med 2009, 150(9):604-612.
• [14]National Kidney Foundation: K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002, 39(2 Suppl 1):S1-S266.
• [15]AlFaleh HF, Alsuwaida AO, Ullah A, Hersi A, AlHabib KF, AlShahrani A, AlNemer K, AlSaif S, Taraben A, Ahmed WH, Balghith MA, Kashour T: Glomerular filtration rate estimated by the CKD-EPI formula is a powerful predictor of in-hospital adverse clinical outcomes after an acute coronary syndrome. Angiology 2012, 63(2):119-126.
• [16]Mielniczuk LM, Pfeffer MA, Lewis EF, Blazing MA, de Lemos JA, Shui A, Mohanavelu S, Califf RM, Braunwald E: Estimated glomerular filtration rate, inflammation, and cardiovascular events after an acute coronary syndrome. Am Heart J 2008, 155(4):725-731.
• [17]Duran M, Uysal OK, Gunebakmaz O, Baran O, Turfan M, Ornek E, Cetin M, Murat SN, Yarlioglues M, Karadeniz M, Kurtul A, Kaya MG: Glomerular filtration rate is associated with burden of coronary atherosclerosis in patients with acute coronary syndrome. Angiology 2014, 65(4):350-356.
• [18]El-Menyar A, Zubaid M, Sulaiman K, Singh R, Al Thani H, Akbar M, Bulbanat B, Al-Hamdan R, Almahmmed W, Al SJ: In-hospital major clinical outcomes in patients with chronic renal insufficiency presenting with acute coronary syndrome: data from a registry of 8176 patients. Mayo Clin Proc 2010, 85(4):332-340.
• [19]Babinska M, Chudek J, Ignacy W, Owczarek A, Prochaczek F, Wicek A: Poor awareness of chronic kidney disease in patients with acute coronary syndrome–challenge for cardiologists and nephrologists. Nephrol Dial Transplant 2009, 24(5):1697-1698.
• [20]Undas A, Nycz K, Pastuszczak M, Stompor T, Zmudka K: The effect of chronic kidney disease on fibrin clot properties in patients with acute coronary syndrome. Blood Coagul Fibrinolysis 2010, 21(6):522-527.
• [21]Berger PB, Best PJ: Does kidney function alter the benefit of reperfusion therapy for ST-segment elevation myocardial infarction? JACC Cardiovasc Interv 2009, 2(1):34-36.
• [22]Medi C, Montalescot G, Budaj A, Fox KA, López-Sendón J, FitzGerald G, Brieger DB, GRACE Investigators: Reperfusion in patients with renal dysfunction after presentation with ST-segment elevation or left bundle branch block: GRACE (Global Registry of Acute Coronary Events). JACC Cardiovasc Interv 2009, 2(1):26-33.
• [23]Goldenberg I, Subirana I, Boyko V, Vila J, Elosua R, Permanyer-Miralda G, Ferreira-González I, Benderly M, Guetta V, Behar S, Marrugat J: Relation between renal function and outcomes in patients with non-ST-segment elevation acute coronary syndrome: real-world data from the European public health outcome research and indicators collection project. Arch Intern Med 2010, 170:888-895.
• [24]Bassand JP, Hamm CW, Ardissino D, Boersma E, Budaj A, Fernández-Avilés F, Fox KA, Hasdai D, Ohman EM, Wallentin L, Wijns W, Task Force for Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of European Society of Cardiology: Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Eur Heart J 2007, 28(13):1598-1660.
• [25]Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, Caso P, Dudek D, Gielen S, Huber K, Ohman M, Petrie MC, Sonntag F, Uva MS, Storey RF, Wijns W, Zahger D, Bax JJ, Auricchio A, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Knuuti J, Kolh P, ESC Committee for Practice Guidelines, et al.: ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the task force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011, 32(23):2999-3054.
• [26]Wann LS, Curtis AB, January CT, Ellenbogen KA, Lowe JE, Estes NA III, Page RL, Ezekowitz MD, Slotwiner DJ, Jackman WM, Stevenson WG, Tracy CM, Fuster V, Rydén LE, Cannom DS, Le Heuzey JY, Crijns HJ, Lowe JE, Curtis AB, Olsson S, Ellenbogen KA, Prystowsky EN, Halperin JL, Tamargo JL, Kay GN, Wann L, Jacobs AK, Anderson JL, Writing Group Members, et al.: 2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (updating the 2006 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011, 123(1):104-123.
• [27]Sadeghi HM, Stone GW, Grines CL, Mehran R, Dixon SR, Lansky AJ, Fahy M, Cox DA, Garcia E, Tcheng JE, Griffin JJ, Stuckey TD, Turco M, Carroll JD: Impact of renal insufficiency in patients undergoing primary angioplasty for acute myocardial infarction. Circulation 2003, 108:2769-2775.
• [28]Yamaguchi J, Kasanuki H, Ishii Y, Yagi M, Ogawa H, Fujii SY, Koganei H, Okada H, Kimura H, Horie T, Haze K, Sumiyoshi T, Honda T, HIJC Study Group: Prognostic significance of serum creatinine concentration for in-hospital mortality in patients with acute myocardial infarction who underwent successful primary percutaneous coronary intervention (from the Heart Institute of Japan Acute Myocardial Infarction [HIJAMI] Registry). Am J Cardiol 2004, 93:1526-1528.
• [29]Vasu S, Gruberg L, Brown DL: The impact of advanced chronic kidney disease on in-hospital mortality following percutaneous coronary intervention for acute myocardial infarction. Catheter Cardiovasc Interv 2007, 70:701-705.
• [30]Hachinohe D, Jeong MH, Saito S, Ahmed K, Hwang SH, Lee MG, Sim DS, Park KH, Kim JH, Hong YJ, Ahn Y, Kang JC, Kim JH, Chae SC, Kim YJ, Hur SH, Seong IW, Hong TJ, Choi D, Cho MC, Kim CJ, Seung KB, Chung WS, Jang YS, Rha SW, Bae JH, Park SJ: Other Korea acute myocardial infarction registry investigators: management of non-ST-segment elevation acute myocardial infarction in patients with chronic kidney disease (from the Korea Acute Myocardial Infarction Registry). Am J Cardiol 2011, 108(2):206-213.
• [31]Inrig JK, Patel UD, Briley LP, She L, Gillespie BS, Easton JD, Topol EJ, Szczech LA: Mortality, kidney disease and cardiac procedures following acute coronary syndrome. Nephrol Dial Transplant 2008, 23:934-940.