Management of Non-ST-Segment Elevation Acute Myocardial Infarction in Patients With Chronic Kidney Disease (from the Korea Acute Myocardial Infarction Registry)

Authors
Daisuke HachinoheMyung Ho JeongShigeru SaitoKhurshid AhmedSeung Hwan HwangMin Goo LeeDoo Sun SimKeun-Ho ParkJu Han KimYoung Joon HongYoungkeun AhnJung Chaee KangJong Hyun KimShung Chull ChaeYoung Jo KimSeung Ho HurIn Whan SeongTaek Jong HongDonghoon ChoiMyeong Chan ChoChong Jin KimKi Bae SeungWook Sung ChungYang Soo JangSeung Woon RhaJang Ho BaeSeung Jung Park
Department
Dept. of Internal Medicine (내과학)
Issue Date
2011
Citation
American Journal of Cardiology, Vol.108(2) : 206-213, 2011
ISSN
0002-9149
Abstract
The aim of this study was to compare clinical outcomes among early invasive (EI), deferred invasive (DI), and conservative strategies in patients with acute non–ST-segment elevation myocardial infarction (NSTEMI) and chronic kidney disease (CKD). High-risk patients with NSTEMI are believed to fare better with an EI strategy, but the optimal treatment for patients with NSTEMI and CKD is not known. In total 5,185 patients with acute NSTEMI were enrolled from the Korea Acute Myocardial Infarction Registry and followed for 1 year. Patients were divided into EI, DI, and conservative treatment groups and classified into 4 stages using references from the National Kidney Foundation. The invasive EI and DI groups were compared to the conservative groups, and the EI and DI groups were compared according to each renal function stage. At 1-year follow-up, mortality rates in the conservative group were significantly higher than in the invasive groups except for the severe CKD group. The benefit of the EI over the DI strategy, although there were no significant differences between the 2 groups, tended to decrease as renal function decreased. In conclusion, in the management of NSTEMI, an invasive strategy decreased mortality compared to a conservative strategy except for severe CKD. In the timing of an invasive strategy, the EI strategy was observed to be superior to the DI strategy in patients with mild CKD; however, this tendency reversed as renal function decreased. When patients with NSTEMI have severe CKD, a conservative or DI strategy with prescription of cardioprotective medications and prevention of further deterioration in renal function should be considered. © 2011 Elsevier Inc. All rights reserved. (Am J Cardiol 2011;108:206–213)
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/34893
Appears in Collections:
1. Journal Papers (연구논문) > 1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
Keimyung Author(s)
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Full Text
https://linkinghub.elsevier.com/retrieve/pii/S0002914911012665
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