liu.seSearch for publications in DiVA
Change search
ReferencesLink to record
Permanent link

Direct link
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)
Karolinska University Hospital.
Danderyd Hospital.
Danderyd Hospital.
Ryhov County Hospital.
Show others and affiliations
2009 (English)In: CIRCULATION, ISSN 0009-7322, Vol. 120, no 10, 851-U55 p.Article in journal (Refereed) Published
Abstract [en]

Background-It is unknown whether patients with non-ST-elevation myocardial infarction derive a similar benefit from an early invasive therapy at different levels of renal function. Methods and Results-A total of 23 262 consecutive non-ST-elevation myocardial infarction patients andlt;= 80 years old were included in a nationwide coronary care unit register between 2003 and 2006. Glomerular filtration rate (eGFR) was estimated with the Modification of Diet in Renal Disease Study formula. Patients were divided into medically or invasively treated groups if revascularized within 14 days of admission. A propensity score for the likelihood of invasive therapy was calculated. A Cox regression model with adjustment for propensity score and discharge medication was used to assess the association between early revascularization and 1-year mortality across renal function stages. There was a gradient, with significantly fewer patients treated invasively with declining renal function: eGFR andgt;= 90 mL . min(-1) . 1.73 m(-2), 62%; eGFR 60 to 89 mL . min(-1) . 1.73 m(-2), 55%; eGFR 30 to 59 mL . min(-1) . 1.73 m(-2), 36%; eGFR 15 to 29 mL . min(-1) . 1.73 m(-2), 14%; and eGFR andlt; 15 mL . min(-1) . 1.73 m(-2)/ dialysis, 15% (P andlt; 0.001). After adjustment, the overall 1-year mortality was 36% lower (hazard ratio 0.64, 95% confidence interval 0.56 to 0.73, P andlt; 0.001) with an invasive strategy. The magnitude of survival difference was similar in normal-to-moderate renal function groups. The lower mortality observed with invasive therapy declined with lower renal function, with no difference in mortality in patients with kidney failure (eGFR andlt; 15 mL . min(-1) . 1.73 m(-2)) or in those receiving dialysis (hazard ratio 1.61, 95% confidence interval 0.84 to 3.09, P=0.15). Conclusions-Early invasive therapy is associated with greater 1-year survival in patients with non-ST-elevation myocardial infarction and mild-to-moderate renal insufficiency, but the benefit declines with lower renal function, and is less certain in those with renal failure or on dialysis.

Place, publisher, year, edition, pages
2009. Vol. 120, no 10, 851-U55 p.
Keyword [en]
kidney, revascularization, myocardial infarction, prognosis
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-20755DOI: 10.1161/CIRCULATIONAHA.108.838169OAI: diva2:236018
Available from: 2009-09-19 Created: 2009-09-18 Last updated: 2009-09-19

Open Access in DiVA

No full text

Other links

Publisher's full text

Search in DiVA

By author/editor
Stenestrand, Ulf
By organisation
Cardiology Faculty of Health SciencesDepartment of Cardiology
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 33 hits
ReferencesLink to record
Permanent link

Direct link