Patients with severe chronic kidney disease benefit from early revascularization after acute coronary syndrome

Authors

Henry D. Huang, Baylor College of Medicine, United States
Mahboob Alam, Baylor College of Medicine, United States
Ihab Hamzeh, Baylor College of Medicine, United States
Salim S. Virani, Baylor College of Medicine, United StatesFollow
Anita Deswal, Baylor College of Medicine, United States
David Aguilar, Baylor College of Medicine, United States
Paul Rogers, Baylor College of Medicine, United States
Panos Kougias, Baylor College of Medicine, United States
Yochai Birnbaum,, Baylor College of Medicine, United States
David Paniagua, Baylor College of Medicine, United States

Document Type

Article

Department

Cardiology

Abstract

Background: Early revascularization is associated with improved outcomes after non-ST-elevation acute coronary syndrome (ACS). It is unclear whether its benefits exist in patients with ACS and advanced chronic kidney disease (CKD), because these patients are often sub-optimally treated and excluded from clinical trials.
Methods: We undertook meta-analyses of short- and long-term mortality outcomes in comparative studies examining the effectiveness of early revascularization in patients with ACS and CKD (as estimated by Glomerular Filtration Rate, eGFR). A literature search between 1995 and 2010 identified 7 published reports enrolling 23,234 patients with at least mild reduction in eGFR (<90 mL/min/1.73 m(2)), of whom 6276 and 16,958 patients received early revascularization versus initial medical therapy, respectively. Summary odds ratios (OR) and their 95% Confidence Intervals (CIs) were calculated using the random-effects models. Sensitivity analyses were performed by one-study removal, and publication bias was assessed by the funnel plot analysis.
Results: Early revascularization was associated with a reduction in 1-year mortality compared to initial medical therapy (OR=0.46, 95% CI 0.26-0.82, P=0.008) among ACS patients with eGFR<60 mL/min/1.73 m(2). The mortality reduction with early revascularization occurred upfront (short term mortality OR=0.69, 95% CI 0.56-0.87, P=0.001), persisted at 3 years (OR=0.54, 95% CI 0.31-0.96, P=0.037), was evident across all CKD stages (including dialysis patients), and was independent of the influence of any single study.
Conclusions: Early revascularization after ACS is associated with reduced mortality in appropriately-selected patients with CKD, including those with severe CKD or receiving dialysis.

Comments

This work was published before the author joined Aga Khan University.

Publication (Name of Journal)

International Journal of Cardiology

Recommended Citation

Huang, H. D., Alam, M., Hamzeh, I., Virani, S. S., Deswal, A., Aguilar, D., Rogers, P., Kougias, P., Birnbaum,, Y., Paniagua, D. (2013). Patients with severe chronic kidney disease benefit from early revascularization after acute coronary syndrome. International Journal of Cardiology, 168(4), 3741-3746.
Available at: https://ecommons.aku.edu/provost_office/223