Introduction:
Earlier trials have shown early invasive intervention improves outcomes in patients with non-ST elevation myocardial infarct (NSTEMI). However, the optimal timing of such intervention in non-dialysis dependent chronic kidney disease (NDD-CKD) remains uncertain. The aim of this study was to compare clinical outcomes between early invasive(EI) and delayed invasive(DI) intervention in patients with NSTEMI and NDD-CKD.
Methods:
We enrolled 534 consecutive patients with NSTEMI and NDD-CKD in COREA-AMI (COnvergent REgistry of cAtholic and chonnAm university for AMI) registry from January 2004 to December 2009. We compared our patients in two groups, who underwent percutaneous coronary intervention (PCI) within 24 hours versus after 24 hours. The primary end point was a composite of major adverse cardiac events (MACE) including all-cause of death, myocardial infarction, and re-admission for management of heart failure.
Results:
307 patients were male (57.5%). Mean age was similar in both groups (70.3 ± 9.7, p=0.689). In multivariate hazard regression analysis, independent predictors were Age≥65 years, left ventricular ejection fraction<50% and no reflow. After adjusted these variables, we analyzed MACE of two groups.
In At 2-year follow-up, MACE in the EI group were significantly higher than in the DI groups by Cox hazard proportional regression model (Hazard ratio 0.443, 95% confidence interval 0.272-0.681) (See Kaplan-Meier curve) .
Conclusions:
Delayed intervention (PCI after 24 hours) can improves outcomes in patients with NSTEMI and NDD-CKD.
Key words:
Non-ST elevation myocardial infarct, Chronic Kidney Disease, Timing
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