Characteristics and in-hospital outcomes of patients presenting with non–ST-segment elevation myocardial infarction found to have significant coronary artery disease on coronary angiography and managed medically: Stratification according to renal function

Background The characteristics, therapies, and outcomes of patients presenting with non–ST-segment elevation myocardial infarction, found to have significant coronary artery disease on coronary angiography, and managed without revascularization (“nonrevascularized patients”) have not been evaluated...

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Published in:The American heart journal 2012-07, Vol.164 (1), p.52-57.e1
Main Authors: Hanna, Elias B., MD, Chen, Anita Y., MS, Roe, Matthew T., MD, Saucedo, Jorge F., MD
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Cardiology
Cardiology. Vascular system
Cardiovascular
Cardiovascular system
Coronary Angiography
Coronary Artery Disease - complications
Coronary Artery Disease - diagnostic imaging
Coronary Artery Disease - mortality
Coronary Artery Disease - physiopathology
Coronary heart disease
Coronary vessels
Electrocardiography
Female
Heart
Heart attacks
Hospital Mortality
Hospitalization
Humans
Investigative techniques, diagnostic techniques (general aspects)
Kidney Function Tests
Male
Medical sciences
Middle Aged
Mortality
Myocardial Infarction - complications
Myocardial Infarction - drug therapy
Myocardial Infarction - mortality
Myocardial Infarction - physiopathology
Myocarditis. Cardiomyopathies
Radiodiagnosis. Nmr imagery. Nmr spectrometry
Renal Insufficiency, Chronic - complications
Retrospective Studies
Severity of Illness Index
Treatment Outcome
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Summary:Background The characteristics, therapies, and outcomes of patients presenting with non–ST-segment elevation myocardial infarction, found to have significant coronary artery disease on coronary angiography, and managed without revascularization (“nonrevascularized patients”) have not been evaluated previously in a large-scale registry. Methods We examined data on 13,872 non–ST-segment elevation myocardial infarction nonrevascularized patients who were captured by the Acute Coronary Treatment and Intervention Outcomes Network registry. Patients were divided according to baseline renal function in 4 groups: no chronic kidney disease (CKD) and CKD stages 3, 4, and 5. Results The in-hospital mortality of nonrevascularized patients was 3.7%, whereas their in-hospital major bleeding rate was 10.8%. Overall, 44.2% (n = 6,132) of nonrevascularized patients had CKD. Compared with patients with normal renal function, nonrevascularized patients with CKD had significantly more history of myocardial infarction, heart failure, more 3-vessel coronary artery disease, and received fewer antithrombotic therapies. In addition, they had significantly higher rates of in-hospital mortality and major bleeding; CKD stage 4 was associated with the highest risk of adverse events. The multivariable-adjusted odds ratios of in-hospital mortality for CKD stages 3, 4, and 5 relative to no CKD were 1.5, 2.5, and 2.2, respectively (global P < .0001), and the analogous adjusted odds ratios of major bleeding were 1.5, 2.5, and 1.8 (global P < .0001). Conclusion Nonrevascularized patients have a high in-hospital mortality. Nonrevascularized patients with CKD have more comorbidities than patients without CKD and less frequently receive guideline-recommended therapies. Chronic kidney disease is strongly associated with in-hospital mortality and bleeding.
ISSN:0002-8703
1097-6744
DOI:10.1016/j.ahj.2012.04.009