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

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Author(s)
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
Publication Year
2011
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)
Department
Dept. of Internal Medicine (내과학)
Publisher
School of Medicine
Citation
American Journal of Cardiology, Vol.108(2) : 206-213, 2011
Type
Article
ISSN
0002-9149
DOI
10.1016/j.amjcard.2011.03.025
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/34893
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