Clinical research studyChronic Kidney Disease in Patients with Non–ST-Segment Elevation Acute Coronary Syndromes
Section snippets
Overall Population
From January 1, 2001, to December 31, 2003, a total of 88 097 patients with non–ST-segment elevation acute coronary syndromes were enrolled in the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse outcomes with Early Implementation of the American College of Cardiology/American Heart Association guidelines) Quality Improvement Initiative. During the study period, 465 US hospitals located in 45 states participated in CRUSADE. The inclusion and exclusion criteria
Clinical Characteristics of the Study Population
Of the 45 343 patients meeting inclusion criteria, 6560 patients (14.5%) were classified as having moderate to severe chronic kidney disease. Patients with moderate to severe chronic kidney disease were older and more likely to have diabetes mellitus, congestive heart failure, and previous coronary artery disease (Table 1). In addition, patients with moderate to severe chronic kidney disease were more likely to present with signs of congestive heart failure and hemodynamic instability.
Early Management and In-Hospital Outcomes
After
Discussion
Our analysis of the CRUSADE Quality Improvement Initiative database shows that patients with moderate to severe chronic kidney disease and non–ST-segment elevation acute coronary syndromes are more likely to have in-hospital complications and less likely to receive American College of Cardiology/American Heart Association guidelines-recommended therapies in the acute setting.
The relationship between impaired creatinine clearance and an increase in post-acute myocardial infarction mortality has
Limitations
Moderate to severe chronic kidney disease was treated as a dichotomous variable; actual serum creatinine values or proteinuria were not recorded, making it impossible to assess the impact of the varying degrees of chronic kidney disease on treatment and outcomes. Similarly, dialysis status was not recorded. Previous studies have reported that only 5.0% to 13.1% of patients with moderate chronic kidney disease to kidney failure are on dialysis.2, 3 As a result, the presence of patients on
Conclusions
Patients with moderate to severe chronic kidney disease and non–ST-segment elevation acute coronary syndromes are at higher risk for death, blood transfusions not related to coronary artery bypass grafting, and cardiogenic shock. Despite these high-risk characteristics, patients with moderate to severe chronic kidney disease are less likely to be treated with antithrombotics, antiplatelets, and invasive procedures. Lack of adherence to the American College of Cardiology/American Heart
References (38)
- et al.
Determinants of mortality after myocardial infarction in patients with advanced renal dysfunction
Am J Kidney Dis
(2001) - et al.
Survival after acute myocardial infarction in patients with end-stage renal diseaseresults from the cooperative cardiovascular project
Am J Kidney Dis
(2000) - et al.
Influence of concurrent renal dysfunction on outcomes of patients with acute coronary syndromes and implications of the use of glycoprotein IIb/IIIa inhibitors
J Am Coll Cardiol
(2003) - et al.
Elevated serum creatinine is associated with 1-year mortality after acute myocardial infarction
Am Heart J
(2002) - et al.
ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction–summary articlea report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients With Unstable Angina)
J Am Coll Cardiol
(2002) - et al.
Clinical epidemiology of cardiovascular disease in chronic renal disease
Am J Kidney Dis
(1998) - et al.
Benefits of aspirin and beta-blockade after myocardial infarction in patients with chronic kidney disease
Am Heart J
(2002) - et al.
Aspirin, beta-blocker, and angiotensin-converting enzyme inhibitor therapy in patients with end-stage renal disease and an acute myocardial infarction
J Am Coll Cardiol
(2003) - et al.
Treatment effects of eptifibatide in planned coronary stent implantation in patients with chronic kidney disease (ESPRIT Trial)
Am J Cardiol
(2003) - et al.
Safety and efficacy of unfractionated heparin versus enoxaparin in patients who are obese and patients with severe renal impairmentanalysis from the ESSENCE and TIMI 11B studies
Am Heart J
(2003)
The impact of renal insufficiency on clinical outcomes in patients undergoing percutaneous coronary interventions
J Am Coll Cardiol
Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification
Am J Cardiol
Analysis of long-term survival after revascularization in patients with chronic kidney disease presenting with acute coronary syndromes
Am J Cardiol
Differential survival after coronary revascularization procedures among patients with renal insufficiency
Kidney Int
Effects of renal insufficiency on early invasive management in patients with acute coronary syndromes (The TACTICS-TIMI 18 Trial)
Am J Cardiol
Review of antithrombotic agents used for acute coronary syndromes in renal patients
Am J Kidney Dis
Poor long-term survival after acute myocardial infarction among patients on long-term dialysis
N Engl J Med
Acute myocardial infarction and renal dysfunctiona high-risk combination
Ann Intern Med
Association of renal insufficiency with treatment and outcomes after myocardial infarction in elderly patients
Ann Intern Med
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2018, European Journal of Internal MedicineCitation Excerpt :Although patients with chest pain deemed safe enough for discharge from an internal medicine ward may still be at risk for adverse outcomes, relatively little is known regarding predictors for poor prognosis in this relatively low risk population. Chronic kidney disease has been associated with both short and long-term adverse outcomes in patients with various cardiovascular conditions including acute coronary syndrome [3,4], congestive heart failure [5] and stroke [6]. A large study covering a community based population of >1.1 million ambulatory patients demonstrated an independent graded association between reduced estimated glomerular filtration rate (eGFR) and the risk of death, cardiovascular events and hospitalizations [7].
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CRUSADE is funded by Millennium Pharmaceuticals, Inc., Cambridge, MA, and Schering Corporation, Kenilworth, NJ. Bristol-Myers Squibb (Plainsboro, NJ)/Sanofi Pharmaceuticals (New York, NY) Partnership provides additional funding support.