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Tomey MI, Chyou JY. Management Considerations for Acute Coronary Syndromes in Chronic Kidney Disease. Curr Cardiol Rep 2024; 26:303-312. [PMID: 38451453 DOI: 10.1007/s11886-024-02039-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE OF REVIEW Propensity of patients with chronic kidney disease (CKD) to adverse outcomes of acute coronary syndromes (ACS) derives, in part, from imperfection in management. Dearth of data resulting from underrepresentation of patients with CKD in ACS trials and underuse of evidence-based testing and therapy compound biological risks inherent to CKD. We sought in this narrative review to critically appraise contemporary evidence and offer suggested approaches to practicing clinicians for the optimization of ACS management in patients with CKD. RECENT FINDINGS Updated multisociety chest pain guidelines emphasize the diversity of clinical presentations of ACS, pertinent to recognition of ACS in patients with CKD. Evolving tools to predict and prevent acute kidney injury complicating invasive management of ACS serve to support improved access to and safety of percutaneous coronary intervention (PCI) in CKD patients, who remain at elevated risk. Growth in use of radial access, advances in PCI quality, incorporation of intravascular imaging, and new options and insights in pharmacotherapy contribute to an evolving calculus of ischemic and bleeding risk in ACS with bearing on management in CKD patients. Key opportunities to improve outcomes of ACS for patients with CKD center on avoiding underuse of beneficial medical and invasive therapies; enhancing safety of therapies by leveraging evidence-based strategies to prevent acute kidney injury; and devoting specific effort to investigation of ACS management in the context of CKD.
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Affiliation(s)
- Matthew I Tomey
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, 1190 Fifth Avenue, Box 1030, New York, NY, 10029, USA.
| | - Janice Y Chyou
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, 1190 Fifth Avenue, Box 1030, New York, NY, 10029, USA
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2
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Demir M, Kahraman F, Sen T, Astarcioglu MA. The relationship of the hemoglobin to serum creatinine ratio with long-term mortality in patients with acute coronary syndrome: A retrospective study. Medicine (Baltimore) 2023; 102:e35636. [PMID: 37832061 PMCID: PMC10578685 DOI: 10.1097/md.0000000000035636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Acute coronary syndrome (ACS) is an urgent clinical condition of cardiovascular diseases. The present study evaluated the predictive efficacy of the hemoglobin to serum creatinine ratio (Hgb/Cr) on long-term mortality in patients with ACS. The ratio, representing the proportion of the 2 values, is cheap, practical, and very easy to calculate at the bedside. Our study included 475 patients who were admitted to the coronary intensive care unit with a diagnosis of ACS and who underwent coronary angiography. The Hgb/Cr ratio was calculated by dividing the admission hemoglobin by the admission serum creatinine. All patient data were collected from the electronic hospital information system, patient files, and the hospital's archive. A comparison of the patients laboratory findings revealed that the Hgb/Cr ratios differed significantly between the survivor and non-survivor group [16.6 (7.7-49) vs 13.8 (4.91-32.8), respectively; P < .001]. A univariate Cox regression analysis showed that the Hgb/Cr ratio was statistically significant in predicting long-term mortality (0.836; 95% confidence interval [CI]: 0.781-0.895; P < .001). After adjusting the model by adding clinically and statistically significant variables, the Hgb/Cr ratio was still an independent predictor of long-term mortality (0.886; 95% CI: 0.815-0.963; P = .004). The Hgb/Cr ratio's discriminant ability was tested with an receiver operating characteristic curve analysis. The Hgb/Cr ratio's area under the curve value was 0.679 (95% CI: 0.609-0.750; P < .001). A survival analysis using the Kaplan-Meier curve of the 2 Hgb/Cr ratio groups (according to cutoff value) revealed that the low-Hgb/Cr group had a significantly higher mortality rate than high-Hgb/Cr group. The Hgb/Cr ratio was found to be an independent predictor of long-term mortality in ACS patients.
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Affiliation(s)
- Mevlut Demir
- Department of Cardiology, Kutahya Health Science University, Kutahya, Turkey
| | - Fatih Kahraman
- Department of Cardiology, Kutahya Training and Research Hospital, Kutahya, Turkey
| | - Taner Sen
- Department of Cardiology, Kutahya Health Science University, Kutahya, Turkey
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Xu F, Wang G, Ye N, Bian W, Yang L, Ma C, Zhao D, Liu J, Hao Y, Liu J, Yang N, Cheng H. Mild renal insufficiency and attributable risk of adverse In-hospital outcomes in patients with Acute Coronary Syndrome from the improving care for Cardiovascular Disease in China (CCC) project. BMC Nephrol 2022; 23:29. [PMID: 35027003 PMCID: PMC8759171 DOI: 10.1186/s12882-022-02663-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background Renal insufficiency (RI) is a frequent comorbidity among patients with acute coronary syndrome (ACS). We aimed to evaluate the attributable risk associated with mild RI for the in-hospital outcomes in patients with ACS. Methods The Improving Care for Cardiovascular Disease in China-ACS (CCC-ACS) Project was a collaborative study of the American Heart Association and the Chinese Society of Cardiology. A total of 92,509 inpatients with a discharge diagnosis of ACS were included. The attributable risk was calculated to investigate the effect of mild RI (eGFR 60-89 ml / min · 1.73 m2) on major adverse cardiovascular events (MACEs) during hospitalization. Results The average age of these ACS patients was 63 years, and 73.9% were men. The proportion of patients with mild RI was 36.17%. After adjusting for other possible risk factors, mild RI was still an independent risk factor for MACEs in ACS patients. In the ACS patients, the attributable risk of eGFR 60-89ml/min·1.73m2 to MACEs was 7.78%, 4.69% of eGFR 45-59 ml/min·1.73m2, 4.46% of eGFR 30-44 ml/min·1.73m2, and 3.36% of eGFR<30 ml/min·1.73m2. Conclusion Compared with moderate to severe RI, mild RI has higher attributable risk to MACEs during hospitalization in Chinese ACS population. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02663-4.
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Petrosyan H, Hayrapetyan H, Torozyan S, Tsaturyan A, Tribunyan S. In-hospital complications in acute ST-elevation myocardial infarction depending on renal function. Herzschrittmacherther Elektrophysiol 2021; 32:359-364. [PMID: 34255141 DOI: 10.1007/s00399-021-00782-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND To analyze in-hospital complications in patients with acute ST-elevation myocardial infarction (STEMI) depending on renal function. DESIGN Observational study in patients with STEMI. METHODS The study included 169 patients undergoing primary percutaneous coronary intervention. In all patients glomerular filtration rate (GRF) was calculated using the Modification of Diet in Renal Disease Study (MDRD) equation. Of these patients, 84 had a GFR ≥ 90 ml/min/1.73 m2 (Group 1) and 85 < 90 ml/min/1.73 m2 (Group 2). Other parameters in both groups were comparable. Study groups were followed to compare Killip class > 2 acute heart failure, in-hospital pneumonia, pulseless ventricular tachycardia or ventricular fibrillation, new onset atrial fibrillation, and high grade atrioventricular block. All patients were treated according to European Society of Cardiology (ESC) guidelines for the management of acute myocardial infarction in patients presenting with ST elevation. RESULTS Mean GFR in Group 1 was 107.6 [Formula: see text] and in Group 2 75.3 [Formula: see text] 11.2 (p < 0.0001). The incidence of atrial fibrillation was higher in Group 2: in Group 1 and Group 2 the atrial fibrillation rate was 1.12% (one of 84) vs 8.24% (seven of 85) (p = 0.031), respectively. Group 1 revealed significantly lower rates of acute heart failure (Killip class > 2): in Group 1 and Group 2 0% (0 of 84 patients) vs 5.88% (five of 85 patients) (p = 0.024), respectively. The authors found no significant differences for other complications: in Group 1 and Group 2 ventricular tachycardia or ventricular fibrillation was 4.76% (four of 84 patients) vs 5.89% (five of 85 patients) (p = 0.75), high grade atrioventricular block was 2.38% (two of 84 patients) vs 4.71% (four of 85 patients) (p = 0.41), and the in-hospital pneumonia rate was 2.38% (two of 84 patients) vs 4.71% (four of 85 patients) (p = 0.41), respectively. CONCLUSION Patients with lower GFR were more likely to suffer from in-hospital acute heart failure (Killip class > 2) and atrial fibrillation in STEMI despite primary percutaneous coronary intervention. Renal function did not affect in-hospital pneumonia, pulseless ventricular tachycardia or ventricular fibrillation rates. The evaluation of kidney function through GFR in STEMI patients may make in-hospital complications more predictable.
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Podestà MA, Valli F, Galassi A, Cassia MA, Ciceri P, Barbieri L, Carugo S, Cozzolino M. COVID-19 in Chronic Kidney Disease: The Impact of Old and Novel Cardiovascular Risk Factors. Blood Purif 2021; 50:740-749. [PMID: 33752209 PMCID: PMC8089440 DOI: 10.1159/000514467] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/14/2021] [Indexed: 01/03/2023]
Abstract
Cardiovascular disease is a frequent complication and the most common cause of death in patients with CKD. Despite landmark medical advancements, mortality due to cardiovascular disease is still 20 times higher in CKD patients than in the general population, which is mainly due to the high prevalence of risk factors in this group. Indeed, in addition to traditional cardiovascular risk factors, CKD patients are exposed to nontraditional ones, which include metabolic, hormonal, and inflammatory alterations. The global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has brought novel challenges for both cardiologists and nephrologists alike. Emerging evidence indicates that coronavirus disease 2019 (COVID-19) increases the risk of cardiovascular events and that several aspects of the disease may synergize with pre-existing cardiovascular risk factors in CKD patients. A better understanding of these mechanisms is pivotal for the prevention and treatment of cardiovascular events in this context, and we believe that additional clinical and experimental studies are needed to improve cardiovascular outcomes in CKD patients with COVID-19. In this review, we provide a summary of traditional and nontraditional cardiovascular risk factors in CKD patients, discussing their interaction with SARS-CoV-2 infection and focusing on CO-VID-19-related cardiovascular complications that may severely affect short- and long-term outcomes in this high-risk population.
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Affiliation(s)
- Manuel Alfredo Podestà
- Renal Division, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Federica Valli
- Cardiology Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, Milan, University of Milan, Milan, Italy
| | - Andrea Galassi
- Renal Division, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Matthias A Cassia
- Renal Division, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Paola Ciceri
- Department of Nephrology, Dialysis and Renal Transplant, Renal Research Laboratory, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Lucia Barbieri
- Cardiology Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, Milan, University of Milan, Milan, Italy
| | - Stefano Carugo
- Cardiology Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, Milan, University of Milan, Milan, Italy
| | - Mario Cozzolino
- Renal Division, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy,
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Ballarino P, Cervellin G, Trucchi C, Altomonte F, Bertini A, Bonfanti L, Bressan MA, Carpinteri G, Noto P, Gavelli F, Molinari L, Patrucco F, Sainaghi PP, Caristia S, Cavazza M, Gallitelli M, Longo S, Cremonesi P, Orsi A, Ansaldi F, Marino R, Di Somma S, Castello LM, Moscatelli P, Avanzi GC. An Italian registry of chest pain patients in the emergency department: clinical predictors of acute coronary syndrome. Minerva Med 2020; 111:120-132. [PMID: 32338841 DOI: 10.23736/s0026-4806.20.06472-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The aim of this study was to describe the population of patients arriving in several Italian Emergency Departments (EDs) complaining of chest pain suggestive of acute coronary syndrome (ACS) in order to evaluate the incidence of ACS in this cohort and the association between ACS and different clinical parameters and risk factors. METHODS This is an observational prospective study, conducted from the 1st January to the 31st December 2014 in 11 EDs in Italy. Patients presenting to ED with chest pain, suggestive of ACS, were consecutively enrolled. RESULTS Patients with a diagnosis of ACS (N.=1800) resulted to be statistically significant older than those without ACS (NO ACS; N.=4630) (median age: 70 vs. 59, P<0.001), and with a higher prevalence of males (66.1% in ACS vs. 57.5% in NO ACS, P<0.001). ECG evaluation, obtained at ED admission, showed new onset alterations in 6.2% of NO ACS and 67.4% of ACS patients. Multiple logistic regression analysis showed that the following parameters were predictive for ACS: age, gender, to be on therapy for cardio-vascular disease (CVD), current smoke, hypertension, hypercholesterolemia, heart rate, ECG alterations, increased BMI, reduced SaO2. CONCLUSIONS Results from this observational study strengthen the importance of the role of the EDs in ruling in and out chest pain patients for the diagnosis of ACS. The analysis put in light important clinical and risk factors that, if promptly recognized, can help Emergency Physicians to identify patients who are more likely to be suffering from ACS.
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Affiliation(s)
- Paola Ballarino
- Emergency Department, San Martino University Hospital, Genoa, Italy
| | | | - Cecilia Trucchi
- Department of Health Science, University of Genoa, Genoa, Italy
| | | | | | - Laura Bonfanti
- Emergency Department, Parma University Hospital, Parma, Italy
| | - Maria A Bressan
- Emergency Department, San Matteo University Hospital, Pavia, Italy
| | | | - Paola Noto
- Emergency Department, Vittorio Emanuele University Hospital, Catania, Italy
| | - Francesco Gavelli
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,Emergency Department, Maggiore della Carità University Hospital, Novara, Italy
| | - Luca Molinari
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,Emergency Department, Maggiore della Carità University Hospital, Novara, Italy
| | - Filippo Patrucco
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,Emergency Department, Maggiore della Carità University Hospital, Novara, Italy
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,Emergency Department, Maggiore della Carità University Hospital, Novara, Italy
| | - Silvia Caristia
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,Emergency Department, Maggiore della Carità University Hospital, Novara, Italy
| | - Mario Cavazza
- Emergency Department, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Mauro Gallitelli
- Emergency Department, SS Giovanni e Paolo Hospital, Venice, Italy
| | - Stefania Longo
- Internal Medicine and Emergency Department, Bari University Hospital, Bari, Italy
| | | | - Andrea Orsi
- Department of Health Science, University of Genoa, Genoa, Italy
| | - Filippo Ansaldi
- Department of Health Science, University of Genoa, Genoa, Italy
| | - Rossella Marino
- Department of Medical-Surgery Sciences and Translational Medicine, Sapienza University, Rome, Italy
| | - Salvatore Di Somma
- Department of Medical-Surgery Sciences and Translational Medicine, Sapienza University, Rome, Italy
| | - Luigi M Castello
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy - .,Emergency Department, Maggiore della Carità University Hospital, Novara, Italy
| | - Paolo Moscatelli
- Emergency Department, San Martino University Hospital, Genoa, Italy
| | - Gian Carlo Avanzi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,Emergency Department, Maggiore della Carità University Hospital, Novara, Italy
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Pilmore HL, Xiong F, Choi Y, Poppe K, Lee M, Legget M, Kerr A. Impact of chronic kidney disease on mortality and cardiovascular outcomes after acute coronary syndrome: A nationwide data linkage study (ANZACS‐QI 44). Nephrology (Carlton) 2020; 25:535-543. [DOI: 10.1111/nep.13703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/09/2020] [Accepted: 01/11/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Helen L. Pilmore
- Department of Renal MedicineAuckland City Hospital Auckland New Zealand
- Department of MedicineAuckland University Auckland New Zealand
| | - Fei Xiong
- Department of Renal MedicineAuckland City Hospital Auckland New Zealand
| | - Yeunhyang Choi
- Section of Epidemiology and Biostatistics, School of Population HealthUniversity of Auckland Auckland New Zealand
| | - Katrina Poppe
- Section of Epidemiology and Biostatistics, School of Population HealthUniversity of Auckland Auckland New Zealand
| | - Mildred Lee
- Section of Epidemiology and Biostatistics, School of Population HealthUniversity of Auckland Auckland New Zealand
| | - Malcolm Legget
- Department of MedicineAuckland University Auckland New Zealand
- Department of CardiologyAuckland City Hospital Auckland New Zealand
| | - Andrew Kerr
- Department of MedicineAuckland University Auckland New Zealand
- Section of Epidemiology and Biostatistics, School of Population HealthUniversity of Auckland Auckland New Zealand
- Department of CardiologyMiddlemore Hospital Auckland New Zealand
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8
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Gender-specific associations between coronary heart disease and other chronic diseases: cross-sectional evaluation of national survey data from adult residents of Germany. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2019; 16:663-670. [PMID: 31645851 PMCID: PMC6790957 DOI: 10.11909/j.issn.1671-5411.2019.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Combinations of coronary heart disease (CHD) and other chronic conditions complicate clinical management and increase healthcare costs. The aim of this study was to evaluate gender-specific relationships between CHD and other comorbidities. Methods We analyzed data from the German Health Interview and Examination Survey (DEGS1), a national survey of 8152 adults aged 18–79 years. Female and male participants with self-reported CHD were compared for 23 chronic medical conditions. Regression models were applied to determine potential associations between CHD and these 23 conditions. Results The prevalence of CHD was 9% (547 participants): 34% (185) were female CHD participants and 66% (362) male. In women, CHD was associated with hypertension (OR = 3.28 (1.81–5.9)), lipid disorders (OR = 2.40 (1.50–3.83)), diabetes mellitus (OR = 2.08 (1.24–3.50)), kidney disease (OR = 2.66 (1.101–6.99)), thyroid disease (OR = 1.81 (1.18–2.79)), gout/high uric acid levels (OR = 2.08 (1.22–3.56)) and osteoporosis (OR = 1.69 (1.01–2.84)). In men, CHD patients were more likely to have hypertension (OR = 2.80 (1.94–4.04)), diabetes mellitus (OR = 1.87 (1.29–2.71)), lipid disorder (OR = 1.82 (1.34–2.47)), and chronic kidney disease (OR = 3.28 (1.81–5.9)). Conclusion Our analysis revealed two sets of chronic conditions associated with CHD. The first set occurred in both women and men, and comprised known risk factors: hypertension, lipid disorders, kidney disease, and diabetes mellitus. The second set appeared unique to women: thyroid disease, osteoporosis, and gout/high uric acid. Identification of shared and unique gender-related associations between CHD and other conditions provides potential to tailor screening, preventive, and therapeutic options.
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Allen LA, Pyart RD, Holmes J, Donovan KL, Anderson RA, Phillips AO. Cardiovascular and renal outcomes following percutaneous coronary intervention in a population with renal disease: a case-control study. QJM 2019; 112:669-674. [PMID: 31161203 DOI: 10.1093/qjmed/hcz130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 05/01/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patients with renal disease are less likely to undergo percutaneous coronary intervention (PCI) due to concerns about poor outcomes. AIM We describe outcomes following PCI in individuals with chronic kidney disease (CKD), as compared with matched controls with comparable CKD who did not undergo PCI. We also identified factors predictive of poor outcomes following PCI amongst patients with CKD. DESIGN Retrospective observational case-control study. METHODS Cases were individuals with CKD (stages 1-5) undergoing PCI between 2008 and 2014. Controls were age, gender and creatinine-matched individuals not requiring PCI. We compared mortality between groups using Kaplan-Meier curves and Cox regression modelling. We assessed changes in serum creatinine using Wilcoxon Rank testing. We explored the relationship between biochemical and haematological measures (baseline creatinine, calcium, phosphate, calcium-phosphate product, parathyroid hormone, white cell count, haemoglobin, platelet count, c-reactive protein and total cholesterol) and post-PCI mortality, using logistic regression. RESULTS We identified 144 cases and 144 controls. Mortality was significantly lower amongst cases compared with controls [hazard ratio 0.46 (95% confidence intervals 0.31, 0.69)]. PCI did not result in a significant change in renal function (P=0.52). Amongst cases, serum creatinine and calcium-phosphate product were predictors of mortality following PCI. CONCLUSION Cases undergoing PCI had lower mortality, and PCI was not associated with accelerated CKD progression. On this data, PCI should not be deferred as a treatment option in patients with CKD. Serum creatinine and calcium-phosphate product predict mortality following PCI in this cohort, and may be useful in risk-stratifying patients with CKD being considered for PCI.
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Affiliation(s)
- L A Allen
- Institute of Nephrology, Cardiff University School of Medicine, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
| | - R D Pyart
- Institute of Nephrology, Cardiff University School of Medicine, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
| | - J Holmes
- Institute of Nephrology, Cardiff University School of Medicine, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
- Welsh Renal Clinical Network, Cwm Taf University Health Board, Wales, UK
| | - K L Donovan
- Institute of Nephrology, Cardiff University School of Medicine, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
| | - R A Anderson
- Department of Cardiology, Cardiff University School of Medicine, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
| | - A O Phillips
- Institute of Nephrology, Cardiff University School of Medicine, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
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10
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The short-term prognostic role of chronic kidney disease in Takotsubo syndrome: Does it really matter? Int J Cardiol 2019; 277:22-23. [DOI: 10.1016/j.ijcard.2018.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 11/19/2022]
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Predictive Value of Baseline High-Sensitivity C-Reactive Protein Level and Renal Function for Patients With Acute Coronary Syndrome Undergoing Aggressive Lipid-Lowering Therapy: A Subanalysis of HIJ-PROPER. Am J Cardiol 2018; 122:1817-1823. [PMID: 30270178 DOI: 10.1016/j.amjcard.2018.08.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/07/2018] [Accepted: 08/13/2018] [Indexed: 11/24/2022]
Abstract
The systematic inflammatory response might confound renal impairment, and both have been reported to affect clinical outcomes after acute coronary syndrome. We examined the impacts of the high-sensitivity C-reactive protein (hsCRP) level and estimated glomerular filtration rate level on the prognosis for acute coronary syndrome patients who underwent aggressive lipid-lowering therapy in contemporary practice. This was a subanalysis of the HIJ-PROPER study, and 1,734 patients were enrolled. Patients were divided into 4 groups using an hsCRP value of 10mg/L and an estimated glomerular filtration rate value of 60 ml/min/1.73 m2 as the cut-off points. Groups were defined as follows: group A, low hsCRP and normal or mild renal impairment; group B, low hsCRP and renal impairment; group C, high hsCRP and normal or mild renal impairment; and group D, high hsCRP and renal impairment. The primary end point was defined as the composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and unstable angina or coronary revascularizations. The median follow-up period was 3.9years, and the follow-up rate was 99%. Compared with group A, the 2 higher hsCRP groups (groups C and D) showed a significantly higher incidence of primary end points (hazard ratio 1.36, 95% confidence interval 1.12 to 1.65, p = 0.002; and hazard ratio 1.40, 95% CI 1.10 to 1.80, p = 0.008). Such a difference was not found compared with group B. In conclusion, patients with higher hsCRP levels had worse prognoses regardless of renal impairment and aggressive lipid-lowering therapy.
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12
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Tomaszuk-Kazberuk A, Nikas D, Lopatowska P, Młodawska E, Malyszko J, Bachorzewska-Gajewska H, Dobrzycki S, Sobkowicz B, Goudevenos I. Patients with Atrial Fibrillation and Chronic Kidney Disease More Often Undergo Angioplasty of Left Main Coronary Artery - a 867 Patient Study. Kidney Blood Press Res 2018; 43:1796-1805. [PMID: 30504712 DOI: 10.1159/000495637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/21/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Several studies have implicated atrial fibrillation (AF) as a contributing factor in chronic kidney disease (CKD) and cardiovascular events. The prevalence of coronary artery disease (CAD) in patients with AF varies substantially from 17% to 46.5%. There are only few studies concerning renal function in population with AF undergoing coronary angiography. The aim of the present study was to assess which type of AF is dominant in CKD population scheduled for coronary angiography and if it can influence patients' outcome, the association between renal impairment and the type of coronary procedures in AF patients and the influence of renal function on in-hospital mortality. METHODS We retrospectively studied 867 patients with AF hospitalized due to coronary angiography in two year time. The cut off value of CKD was eGFR ≤ 60 ml/min./1.73m2 evaluated by CKD-EPI formula. RESULTS A total of 867 patients with AF (44% women; mean age 72±10 years) were included in the analysis. The mean eGFR was 44±11ml/min./1.73m2 in patients with CKD and 89±18 ml/min./1.73m2 in patients with preserved renal function. Patients with CKD and AF were older (p< 0.001), had more often diabetes (p=0.009), heart failure (p< 0.001) and anaemia (p< 0.001). Patients with CKD and AF had more often permanent type of AF (p< 0.001). In CKD patients CHA2DS2VASc score was 4.3±1.5 and HAS-BLED score was 2.0±1.2 and it was significantly higher as compared to population with preserved renal function (p< 0.001, p=0.02, respectively). The use of oral anticoagulation was less frequent in CKD group (p< 0.001) although these patients had higher CHA2DS2VASc score. Patients with AF and CKD were more often admitted due to myocardial infarction (STEMI or NSTEMI) (p=0.02, p< 0.001, respectively) and more often underwent percutaneous coronary intervention (PCI) (p=0.01). Among coronary arteries the percutaneous coronary intervention (PCI) of left main artery was done more frequently in CKD patients (p=0.01). Among CKD population in-hospital mortality was significantly higher in patients with eGFR < 30 ml/min (p< 0.001). CONCLUSION Patients with CKD had more often permanent type of AF. Percutaneous interventions of the left main coronary artery, the only elective procedures influencing patients' prognosis, were done more frequently in CKD patients with AF. In-hospital mortality was significantly higher in patients with severe renal impairment. Despite the higher risk of ischaemic stroke in CKD group the use of oral anticoagulation therapy was significantly less frequent and the patients were deprived of the confirmed benefits of such treatment.
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Affiliation(s)
| | - Dimitrios Nikas
- Cardiology Department, Ioannina University Hospital, Ioannina, Greece
| | - Paulina Lopatowska
- Department of Cardiology, Medical University in Bialystok, Bialystok, Poland
| | - Elzbieta Młodawska
- Department of Cardiology, Medical University in Bialystok, Bialystok, Poland
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - Hanna Bachorzewska-Gajewska
- Department of Invasive Cardiology, Medical University in Bialystok, Bialystok, Poland.,Department of Clinical Medicine, Medical University in Bialystok, Bialystok, Poland
| | - Slawomir Dobrzycki
- Department of Invasive Cardiology, Medical University in Bialystok, Bialystok, Poland
| | - Bożena Sobkowicz
- Department of Cardiology, Medical University in Bialystok, Bialystok, Poland
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13
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Quantitative analysis of late gadolinium enhancement in hypertrophic cardiomyopathy: comparison of diagnostic performance in myocardial fibrosis between gadobutrol and gadopentetate dimeglumine. Int J Cardiovasc Imaging 2017; 33:1191-1200. [DOI: 10.1007/s10554-017-1101-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/24/2017] [Indexed: 01/20/2023]
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14
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Liang Z, Li Y, Wang J, Wang D, Wang S, Ma L, Liu H, Yang L, Stone GW, Han Y. The safety and effectiveness of bivalirudin in female patients with acute myocardial infarction undergoing primary angioplasty: A subgroup analysis of the BRIGHT trial. Catheter Cardiovasc Interv 2016; 87 Suppl 1:608-15. [PMID: 26762481 DOI: 10.1002/ccd.26407] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 12/21/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND Being female is an independent predictor of adverse events during percutaneous coronary interventions (PCI). OBJECTIVE To evaluate the safety and efficiency of bivalirudin during emergency PCI in female patients with acute myocardial infarction (AMI). METHODS The present study was a subgroup analysis of the randomized Bivalirudin in Acute Myocardial Infarction vs. Heparin and GPI plus Heparin (BRIGHT) trial. A total of 392 female patients enrolled in the BRIGHT trial were assigned to receive bivalirudin with post-procedure dose infusion (n = 127) or heparin with or without tirofiban (n = 265). The primary efficiency endpoint was 30-day net adverse clinical events (NACEs). The secondary efficiency endpoints were 30-day major cardiac and cerebral events (MACCEs) and bleeding events defined according to Bleeding Academic Research Consortium (BARC) definitions. RESULTS For female patients, bivalirudin treatment was associated with significantly lower incidences of 30-day NACEs (6.3% vs. 21.5%, P < 0.001), any bleeding (2.4% vs. 12.8%, P = 0.001) and BARC 2-5 type bleeding (1.6% vs. 7.2%, P = 0.021) compared with the control regimen. The incidence of MACCEs (3.4% vs. 9.4%, P = 0.055) and stent thrombosis (0% vs. 1.1%, P = 0.229) were comparable between the two groups. Multivariate analysis showed that bivalirudin (OR: 0.245, 95% CI: 0.113-0.532, P < 0.001), transradial access (OR: 0.119, 95% CI: 0.067-0.211, P < 0.001), and statin (OR: 0.254, 95% CI: 0.08-0.807, P = 0.02) were independent protective factors for 30-day NACEs in female patients. CONCLUSIONS The use of bivalirudin during emergency PCI for AMI in female patients significantly reduced the bleeding risk with anticoagulation effects compared with heparin with or without tirofiban.
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Affiliation(s)
- Zhenyang Liang
- General Hospital of Shenyang Military Region, Shenyang, Liaoning Province, China
| | - Yi Li
- General Hospital of Shenyang Military Region, Shenyang, Liaoning Province, China
| | - Jingping Wang
- Shanxi Cardiovascular Hospital, Taiyuan, Shanxi Province, China
| | - Dongmei Wang
- Shijiazhuang Peace Hospital, Shijiazhuang, Hebei Province, China
| | - Shouli Wang
- No. 306 Hospital of PLA, Beijing, Beijing City, China
| | - Likun Ma
- Anhui Provincial Hospital, Hefei, Anhui Province, China
| | - Huiliang Liu
- Beijing CAPF General Hospital, Beijing, Beijing City, China
| | - Lixia Yang
- Kunming General Hospital of Chengdu Military Region, Kunming, Yunnan Province, China
| | - Gregg W Stone
- Columbia University Medical Center and the Cardiovascular Research Foundation, New York
| | - Yaling Han
- General Hospital of Shenyang Military Region, Shenyang, Liaoning Province, China
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15
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Renal insufficiency was correlated with 2-year mortality for rural female patients with ST-segment elevation acute myocardial infarction after reperfusion therapy: a multicenter, prospective study. BMC Cardiovasc Disord 2015; 15:179. [PMID: 26702638 PMCID: PMC4690416 DOI: 10.1186/s12872-015-0174-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 12/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Renal insufficiency (RI) following ST-segment elevation acute myocardial infarction (STEMI) is associated with a worse clinical prognosis. We investigated the impact of RI on long-term mortality in rural female patients with STEMI and evaluated prognostic factors. METHODS A prospective cohort study of 436 consecutive rural female patients who were successfully treated with reperfusion therapy for STEMI between May 2009 and August 2011 in secondary care hospitals in Liaoning province northeastern China and followed up for 2 years. Patients were divided into three groups by estimated glomerular filtration rate (eGFR): Normal group, eGFR ≥90 mL/min/1.73 m(2) (n = 233). Moderate group, eGFR 60-90 mL/min/1.73 m(2) (n = 108). RI group, eGFR <60 mL/min/1.73 m(2) (n = 95). The primary outcome was 2-year mortality. RESULTS During follow-up (mean 741 ± 118 days), the RI group had a significantly higher mortality than the other groups (24.21 % vs. 6.87 % and 10.19 %, p < 0.001). The RI group had significantly higher hospital mortality (7.37 % p = 0.045 vs. Normal group). RI increased the risk of hospital mortality (hazard ratio (HR) 1.832, 95 % CI 1.017-3.091, p = 0.033), and increased the risk of 2-year mortality (HR 3.872, 95 % CI 2.004-6.131, p < 0.001). Multivariate analysis showed eGFR <90 ml/min/1.73 m(2) and age ≥75 years as independent predictors of mortality at 2 years. In detail these were eGFR 60-90 ml/min/1.73 m(2) with HR 2.081, 95%CI 1.250-2.842, p < 0.001; eGFR <60 ml/min/1.73 m(2) with HR 3.872, 95%CI 2.004-6.131, p < 0.001; age ≥75 with HR 1.461, 95%CI 1.011-1.952, p = 0.024. CONCLUSIONS RI had a powerful correlation with long-term mortality for rural female patients with STEMI after reperfusion therapy.
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Wetmore JB, Tang F, Sharma A, Jones PG, Spertus JA. The association of chronic kidney disease with the use of renin-angiotensin system inhibitors after acute myocardial infarction. Am Heart J 2015; 170:735-43. [PMID: 26386797 DOI: 10.1016/j.ahj.2015.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/20/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Renin-angiotensin system (RAS) inhibitor use after acute myocardial infarction (AMI) is a quality indicator, but there may also be reasons not to use this therapy. We sought to determine how chronic kidney disease (CKD) and acute kidney injury (AKI) affected RAS inhibitor prescription after AMI in patients with and without decreased ejection fraction (EF). METHODS Participants from the TRIUMPH registry were categorized by admission estimated glomerular filtration rate (eGFR in mL/min per 1.73 m(2); severe [<30], moderate [30-59], mild [60-89], and no [≥90] CKD) and occurrence of AKI (an increase in creatinine ≥0.3 mg/dL or ≥50%). Renin-angiotensin system inhibitor prescriptions at discharge were compared across categories of CKD, AKI, and decreased EF (<40% vs ≥40%) using a hierarchical modified Poisson model. RESULTS Among 4,223 AMI patients (mean age 59.0 years, 67.0% male, 67.3% white), RAS inhibitor use decreased significantly with lower eGFR (P < .001), but there was no effect of decreased EF on this relationship (interaction P = .40). Without AKI, severe and moderate CKD were associated with significantly less RAS inhibitor use: relative risks (RRs) 0.67 (95% CIs, 0.58-0.78) and 0.94 (0.90-0.99), respectively. When AKI occurred, CKD was associated with less RAS inhibitor use: RRs 0.84 (0.76-0.93) for mild CKD, 0.78 (0.68-0.88) for moderate CKD, and 0.50 (0.42-0.61) for severe CKD. Ejection fraction <40% was associated with use (RR 1.11, 1.03-1.18), independent of renal function. CONCLUSIONS Chronic kidney disease and AKI are associated with fewer RAS inhibitor prescriptions at discharge, but in both AKI and non-AKI patients, eGFR was more strongly associated with use than EF.
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Single-dose gadobutrol in comparison with single-dose gadobenate dimeglumine for magnetic resonance imaging of chronic myocardial infarction at 3 T. Invest Radiol 2015; 49:728-34. [PMID: 24872002 PMCID: PMC4196783 DOI: 10.1097/rli.0000000000000076] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The aim of this study was to compare the contrast-to-noise ratio (CNR) values of infarct and remote myocardium as well as infarct and blood after application of 0.1 mmol/kg gadobutrol and 0.1 mmol/kg gadobenate dimeglumine on late gadolinium enhancement magnetic resonance (MR) images. MATERIAL AND METHODS The study was a prospective randomized controlled clinical study. After informed consent was obtained, 20 patients (12 men, 8 women; mean age, 67 ± 11 years) with known chronic myocardial infarction were included for an intraindividual comparison of a single-dose gadobutrol and a single-dose gadobenate dimeglumine. Two MR imaging examinations were performed within a period of 28 days in a crossover design. Late gadolinium enhancement imaging was performed 10 minutes after gadolinium administration using a 2-dimensional phase-sensitive inversion recovery gradient echo sequence at 3 T. Infarct size, signal intensities (SIs), signal-to-noise ratio, and CNR were determined on phase-sensitive MR images. Values for CNR were calculated as CNRinfarct/myocardium = (SIinfarct - SImyocardium)/SDnoise and CNRinfarct/blood = (SIinfarct - SIblood)/SDnoise. In addition, the areas of myocardial infarction were determined on single slices. The entire infarct volumes were calculated by adding the areas with hyperenhancement multiplied by the slice thickness. RESULTS Late gadolinium enhancement was present in all patients. Median values of the infarct area, infarct volume, and transmurality for gadobutrol and gadobenate dimeglumine showed good to excellent concordance (rc = 0.85, rc = 0.95, and rc = 0.71, respectively). The mean signal-to-noise ratio values for infarct, remote myocardium, and ventricular blood were 18.6 ± 6.5, 4.1 ± 3.7, and 14.6 ± 7.5, respectively, for gadobutrol and 18.8 ± 8.9, 4.9 ± 4.5, and 17.8 ± 10.1, respectively, for gadobenate dimeglumine (P = 0.93, P = 0.48, and P = 0.149, respectively). The mean values of CNRinfarct/myocardium and CNRinfarct/blood were 14.5 ± 5.9 and 4.0 ± 4.6, respectively, for gadobutrol and 13.9 ± 6.1 and 0.9 ± 4.5, respectively, for gadobenate dimeglumine (P = 0.69 and P = 0.02, respectively). CONCLUSION Both gadobutrol and gadobenate dimeglumine allow for successful late gadolinium enhancement imaging of chronic myocardial infarction after a single-dose application (0.1 mmol/kg) at 3 T. Gadobutrol provides a higher CNR between infarct and blood. The CNRs between infarct and normal myocardium, infarct size, and transmural extent were similar for both contrast agents.
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18
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Vogel B, Farhan S, Hahne S, Kozanli I, Kalla K, Freynhofer MK, Jarai R, Kautzky-Willer A, Huber K. Sex-related differences in baseline characteristics, management and outcome in patients with acute coronary syndrome without ST-segment elevation. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 5:347-53. [PMID: 25954017 DOI: 10.1177/2048872615585514] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 04/15/2015] [Indexed: 11/15/2022]
Abstract
AIM To detect sex-related differences in baseline characteristics, management and outcome in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). METHODS Data from 812 consecutive patients admitted to our cardiology department for NSTE-ACS between 2001 and 2004 were obtained. Early invasive therapy was defined as revascularization during first hospital stay. A seven-year follow-up for the clinical endpoint of all-cause mortality could be obtained in 342 women and 440 men, respectively. RESULTS Compared with men, women were significantly older and more likely to suffer from renal insufficiency. The proportion treated with clopidogrel at admission was 43.6% for women and 52.7% for men, respectively (p=0.011). Significantly fewer women underwent an early invasive therapy compared with men (27.5% vs. 35.2%; p=0.021). Age and renal insufficiency were the strongest predictors for a conservative approach in both female and male patients. After adjustment for baseline characteristics there was no significant difference in treatment between women and men (odds ratio 0.89; 95% confidence interval 0.59-1.35; p=0.588). While in-hospital mortality was similar between the sexes, long-term mortality was significantly higher in women compared with men (8.2% vs. 7.0%; p=0.549 for in-hospital mortality and 54.8% vs. 39.3%; p<0.001 for seven-year mortality). However, after adjustment for baseline characteristics and treatment there was no significant difference in long-term mortality between women and men (hazard ratio 1.14; 95% confidence interval 0.89-1.47; p=0.307). CONCLUSION In these patients with NSTE-ACS women were less likely to undergo an early invasive therapy compared with men due to their higher age and the higher rate of renal insufficiency. After adjustment for age, comorbidities and treatment female sex was not associated with worse long-term outcome.
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Affiliation(s)
- Birgit Vogel
- 3rd Medical Department with Cardiology, Wilhelminen Hospital, Vienna, Austria
| | - Serdar Farhan
- 3rd Medical Department with Cardiology, Wilhelminen Hospital, Vienna, Austria
| | - Sarah Hahne
- 3rd Medical Department with Cardiology, Wilhelminen Hospital, Vienna, Austria
| | - Ilyas Kozanli
- 3rd Medical Department with Cardiology, Wilhelminen Hospital, Vienna, Austria
| | - K Kalla
- 3rd Medical Department with Cardiology, Wilhelminen Hospital, Vienna, Austria
| | | | - Rudolf Jarai
- 3rd Medical Department with Cardiology, Wilhelminen Hospital, Vienna, Austria
| | - Alexandra Kautzky-Willer
- 3rd Medical Department, Division of Endocrinology and Metabolism, Medical University of Vienna, Austria
| | - Kurt Huber
- 3rd Medical Department with Cardiology, Wilhelminen Hospital, Vienna, Austria
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Zalewska-Adamiec M, Bachorzewska-Gajewska H, Malyszko J, Malyszko JS, Kralisz P, Tomaszuk-Kazberuk A, Hirnle T, Dobrzycki S. Chronic kidney disease in patients with significant left main coronary artery disease qualified for coronary artery bypass graft operation. Arch Med Sci 2015; 11:446-52. [PMID: 25995765 PMCID: PMC4424263 DOI: 10.5114/aoms.2015.50978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 01/29/2013] [Accepted: 05/28/2013] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - Hanna Bachorzewska-Gajewska
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
- Department of Clinical Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Jolanta Malyszko
- Department of Nephrology, Transplantation with Dialysis Center, Medical University of Bialystok, Bialystok, Poland
| | - Jacek S. Malyszko
- Department of Nephrology, Transplantation with Dialysis Center, Medical University of Bialystok, Bialystok, Poland
| | - Pawel Kralisz
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | | | - Tomasz Hirnle
- Department of Cardiac Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Slawomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
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20
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Marenzi G, Cabiati A, Cosentino N, Assanelli E, Milazzo V, Rubino M, Lauri G, Morpurgo M, Moltrasio M, Marana I, De Metrio M, Bonomi A, Veglia F, Bartorelli A. Prognostic significance of serum creatinine and its change patterns in patients with acute coronary syndromes. Am Heart J 2015; 169:363-70. [PMID: 25728726 DOI: 10.1016/j.ahj.2014.11.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 11/21/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND In acute coronary syndromes (ACS), serum creatinine (sCr) levels have short- and long-term prognostic value. However, it is possible that repeated evaluations of sCr during hospitalization, rather than measuring sCr value at admission only, might improve risk assessment. We investigated the relationship between sCr baseline value, its changes, and in-hospital mortality in patients hospitalized with ACS. METHODS In 2,756 ACS patients, sCr was measured at hospital admission and then daily, until discharge from coronary care unit. Patients were grouped according to the maximum sCr change observed: <0.3 mg/dL change from baseline (stable renal function [SRF] group), ≥0.3 mg/dL decrease (improved renal function [IRF] group), and ≥0.3 mg/dL increase (worsening renal function [WRF] group). RESULTS Of the 2,756 patients, 2,163 (78%) had SRF, 292 (11%) had IRF, and 301 (11%) had WRF. In-hospital mortality in the 3 groups was 0.5%, 2%, and 14% (P < .001), respectively. Peak sCr value was a more powerful predictor of mortality (area under the curve 0.86, 95% CI 0.81-0.92) than the initial sCr value (area under the curve 0.69, 95% CI 0.63-0.77; P < .001). When sCr and its change patterns during coronary care unit stay were evaluated together, improved mortality risk stratification was found. CONCLUSIONS In ACS patients, daily sCr value and its change pattern are stronger predictors of in-hospital mortality than the initial sCr value only; thus, their combined evaluation provides a more accurate and dynamic stratification of patients' risk. Finally, the intermediate mortality risk of IRF patients possibly reflects acute kidney injury started before hospitalization.
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21
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Tabeta K, Yoshie H, Yamazaki K. Current evidence and biological plausibility linking periodontitis to atherosclerotic cardiovascular disease. JAPANESE DENTAL SCIENCE REVIEW 2014. [DOI: 10.1016/j.jdsr.2014.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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22
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Said S, Hernandez GT. The link between chronic kidney disease and cardiovascular disease. J Nephropathol 2014; 3:99-104. [PMID: 25093157 PMCID: PMC4119330 DOI: 10.12860/jnp.2014.19] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 05/13/2014] [Indexed: 01/09/2023] Open
Abstract
CONTEXT It is well known that patients with chronic kidney disease (CKD) have a strong risk of cardiovascular disease (CVD). However, the excess risk of cardiovascular disease in patients with CKD is only partially explained by the presence of traditional risk factors, such as hypertension and diabetes mellitus. EVIDENCE ACQUISITIONS Directory of Open Access Journals (DOAJ), Google Scholar, PubMed, EBSCO and Web of Science has been searched. RESULTS Chronic kidney disease even in its early stages can cause hypertension and potentiate the risk for cardiovascular disease. However, the practice of intensive blood pressure lowering was criticized in recent systematic reviews. Available evidence is inconclusive but does not prove that a blood pressure target of less than 130/80 mmHg as recommended in the guidelines improves clinical outcomes more than a target of less than 140/90 mmHg in adults with CKD. CONCLUSIONS The association between CKD and CVD has been extensively documented in the literature. Both CKD and CVD share common traditional risk factors, such as smoking, obesity, hypertension, diabetes mellitus, and dyslipidemia. However, cardiovascular disease remains often underdiagnosed und undertreated in patients with CKD. It is imperative that as clinicians, we recognize that patients with CKD are a group at high risk for developing CVD and cardiovascular events. Additional studies devoted to further understand the risk factors for CVD in patients with CKD are necessary to develop and institute preventative and treatment strategies to reduce the high morbidity and mortality in patients with CKD.
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Affiliation(s)
| | - German T. Hernandez
- Division of Nephrology & Hypertension, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center at El Paso, El Paso, Texas, USA
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23
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Lin TH, Lai WT, Kuo CT, Hwang JJ, Chiang FT, Chang SC, Chang CJ. Additive effect of in-hospital TIMI bleeding and chronic kidney disease on 1-year cardiovascular events in patients with acute coronary syndrome: Data from Taiwan Acute Coronary Syndrome Full Spectrum Registry. Heart Vessels 2014; 30:441-50. [PMID: 24802367 PMCID: PMC4521085 DOI: 10.1007/s00380-014-0504-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 03/14/2014] [Indexed: 01/18/2023]
Abstract
In-hospital bleeding (IHB) is associated with the risk of subsequent cardiovascular events (CVE) in acute coronary syndrome (ACS). We investigated whether increased risk of CVE by IHB is influenced by chronic kidney disease (CKD) or both have detrimental effects on CVE. In a Taiwan national-wide registry, 2819 ACS patients were enrolled. CKD is defined as an estimated glomerular filtration rate of <60 ml/min per 1.73 m2. The primary end point is the composite of death, non-fatal myocardial infarction and non-fatal stroke at 12 months. 53 (1.88 %) and 949 (33.7 %) patients suffered from IHB and CKD, respectively. Both IHB and CKD are independently associated with increased risk of the primary end point (HR 2.04, 95 % CI 1.05–3.99, p = 0.037 and HR 2.17, 95 % CI 1.63–2.87, p < 0.01, respectively). The Kaplan–Meier curves show significantly higher event rates among those with IHB and CKD in the whole, ST-elevation and non-ST elevation populations (all p < 0.01). Patients with IHB(+)/CKD(−), IHB(−)/CKD(+) and IHB(+)/CKD(+) have 1.88-, 2.13- and 2.98-fold risk to suffer from the primary end point compared with those without IHB and CKD (p = 0.23, <0.01 and <0.01, respectively). IHB or CKD is independently associated with poor cardiovascular outcome and patients with both IHB and CKD have the worst outcome in ACS.
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Affiliation(s)
- Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, No.100 Tzyou 1st Road, Kaohsiung, 80708 Taiwan, ROC
- Department of Internal Medicine, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Ter Lai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, No.100 Tzyou 1st Road, Kaohsiung, 80708 Taiwan, ROC
- Department of Internal Medicine, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Tai Kuo
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Division of Cardiology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Fu-Tien Chiang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Chen Chang
- Division of Biostatistics, Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Chee-Jen Chang
- Graduate Institute of Clinical Medicine, Research Center for Clinical Informatics and Medical Statistics, Chang Gung University, Taoyuan, Taiwan
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Gouri A, Dekaken A, Bentorki AA, Touaref A, Yekhlef A, Sekkache F, Kouicem N. Serum uric acid level and cardiovascular risks in hemodialysis patients: an Algerian cohort study. Pak J Biol Sci 2014; 16:852-8. [PMID: 24498838 DOI: 10.3923/pjbs.2013.852.858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Elevated Serum Uric Acid (SUA) was usually associated with an increased risk of cardiovascular events and mortality in general population. However, there are few reports concerning the clinical impact and the pathogenic role of Uric Acid (UA) in Hemodialysis (HD) patients. The aim of the study was to investigate the relationship between SUA and various Cardiovascular (CV) risk factors in HD patients. This retrospective; observational cohort study includes 45 HD patients with a mean age of 51.26+/-15.21 years. The differences of the CV risk factors between the patients according to their SUA levels were investigated. Age, Cardiovascular Diseases (CVD), increased creatinine, Fasting Blood Glucose (FBG), Corrected Calcium (cCa), Phosphate (P), cCa x P product and LDL cholesterol levels were associated with lower SUA levels, whereas higher SUA level was associated with Diabetes Mellitus (DM), hypertension and increased triglycerides level (p<0.01). In multiple regression analysis, history of diabetes (beta= 0.360, p<0.05), reduced corrected serum calcium (cCa) (beta = -1.456, p<0.01) and Phosphate (P) levels (beta= -1.752, p<0.01) were predictive of an increased SUA concentration. Despite from what has been demonstrated in the general population and DM patients, a lower SUA level in HD patients was associated with higher cardiovascular risk factors and high co-morbidity burden. Moreover, higher SUA concentrations may be cardioprotective in dialysis patients.
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Affiliation(s)
- Adel Gouri
- Laboratory of Medical Biochemistry, IBN ZOHR Hospital, Guelma 24000, Algeria
| | - Aoulia Dekaken
- Department of Internal Medicine and cardiology, EL OKBI Hospital, Guelma 24000, Algeria
| | | | - Amel Touaref
- Department of Infection Diseases, IBN ZOHR Hospital, Guelma 24000, Algeria
| | - Amina Yekhlef
- Department of Hematology, IBN ZOHR Hospital, Guelma 24000, Algeria
| | - Fouzia Sekkache
- Laboratory of Medical Biochemistry, IBN ZOHR Hospital, Guelma 24000, Algeria
| | - Nabila Kouicem
- Department of Nephrology and Hemodialysis, IBN ZOHR Hospital, 24000 Guelma, Algeria
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Rohla M, Freynhofer MK, Tentzeris I, Farhan S, Wojta J, Huber K, Weiss TW. Plasma osmolality predicts clinical outcome in patients with acute coronary syndrome undergoing percutaneous coronary intervention. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2013; 3:84-92. [PMID: 24337920 DOI: 10.1177/2048872613516018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIMS The impact of plasma osmolality on clinical outcome in acute coronary syndrome (ACS) patients has not been investigated so far. METHODS In a retrospective analysis, we included 985 patients with ACS undergoing percutaneous coronary intervention (PCI). Plasma osmolality was calculated using concentrations of sodium, plasma glucose, and blood urea nitrogen at admission. Patients were stratified by quartiles (Q) of admission osmolality, clinical outcome was compared between those groups. The primary endpoints were in-hospital, 30-day, and 1-year mortality. RESULTS Univariate analysis in the Cox proportional-hazards model revealed significantly higher rates of in-hospital death for patients with osmolality in Q4, as compared to patients with osmolality in Q1-3 (HR 5.4, 95% CI 3.3-9.0, p<0.01). After adjustment for confounding baseline variables, osmolality in Q4 was associated with 2.8-fold hazard of in-hospital death (HR 2.75, 95% CI 1.35-5.61, p=0.005). Upon multivariate analysis, admission osmolality in Q4 vs. Q1-3 was associated with higher mortality rates after 30 days (HR 2.53, 95% CI 1.23-5.21, p=0.012) and 1 year (HR 1.73, 95% CI 1.02-2.91, p=0.04). Moreover, we performed landmark analysis in order to exclude critically ill patients, which revealed similar adjusted rates of death beyond 30 days to 1 year (HR 1.21, 95% CI 0.55-2.66, p=0.642). CONCLUSIONS Using the 4th quartile of plasma osmolality at admission as a natural cut-off point, osmolality in Q4, as compared to Q1-3, was significantly predictive of short term but not long-term outcome in ACS patients undergoing coronary stenting. Our data suggest osmolality to be an independent, feasible, and cost-effective tool for rapid risk stratification in ACS patients.
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Narala KR, Hassan S, LaLonde TA, McCullough PA. Management of coronary atherosclerosis and acute coronary syndromes in patients with chronic kidney disease. Curr Probl Cardiol 2013; 38:165-206. [PMID: 23590761 DOI: 10.1016/j.cpcardiol.2012.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atherosclerosis of the coronary arteries is common, extensive, and more unstable among patients with chronic renal impairment or chronic kidney disease (CKD). The initial presentation of coronary disease is often acute coronary syndrome (ACS) that tends to be more complicated and has a higher risk of death in this population. Medical treatment of ACS includes antianginal agents, antiplatelet therapy, anticoagulants, and pharmacotherapies that modify the natural history of ventricular remodeling after injury. Revascularization, primarily with percutaneous coronary intervention and stenting, is critical for optimal outcomes in those at moderate and high risk for reinfarction, the development of heart failure, and death in predialysis patients with CKD. The benefit of revascularization in ACS may not extend to those with end-stage renal disease because of competing sources of all-cause mortality. In stable patients with CKD and multivessel coronary artery disease, observational studies have found that bypass surgery is associated with a reduced mortality as compared with percutaneous coronary intervention when patients are followed for several years. This article will review the guidelines-recommended therapeutic armamentarium for the treatment of stable coronary atherosclerosis and ACS and give specific guidance on benefits, hazards, dose adjustments, and caveats concerning patients with baseline CKD.
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Effects of clopidogrel on mortality, cardiovascular and bleeding outcomes in patients with chronic kidney disease - data from Taiwan acute coronary syndrome full spectrum registry. PLoS One 2013; 8:e71917. [PMID: 24015198 PMCID: PMC3756021 DOI: 10.1371/journal.pone.0071917] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 07/04/2013] [Indexed: 11/19/2022] Open
Abstract
Background The efficacy of clopidogrel is inconclusive in the chronic kidney disease (CKD) population with acute coronary syndrome (ACS). Furthermore, CKD patients are prone to bleeding with antiplatelet therapy. We investigated the efficacy and safety of clopidogrel in patients with ACS and CKD. Methods In a Taiwan national-wide registry, 2819 ACS patients were enrolled. CKD is defined as an estimated glomerular filtration rate of less than 60 ml/min per 1.73 m2. The primary endpoints are the combined outcomes of death, non-fatal myocardial infarction and stroke at 12 months. Results Overall 949 (33.7%) patients had CKD and 2660 (94.36%) patients received clopidogrel treatment. CKD is associated with increased risk of the primary endpoint at 12 months (HR 2.39, 95% CI 1.82 to 3.15, p<0.01). Clopidogrel use is associated with reduced risk of the primary endpoint at 12 months (HR 0.42, 95% CI: 0.29–0.60, p<0.01). Cox regression analysis showed that clopidogrel reduced death and primary endpoints for CKD population (HR 0.35, 95% CI: 0.21–0.61 and HR 0.48, 95% CI: 0.30–0.77, respectively, both p<0.01). Patients with clopidogrel(−)/CKD(−), clopidogrel(+)/CKD(+) and clopidogrel(−)/CKD(+) have 2.4, 3.0 and 10.4 fold risk to have primary endpoints compared with those receiving clopidogrel treatment without CKD (all p<0.01). Clopidogrel treatment was not associated with increased in-hospital Thrombolysis In Myocardial Infarction (TIMI) bleeding in CKD population. Conclusion Clopidogrel could decrease mortality and improve cardiovascular outcomes without increasing risk of bleeding in ACS patients with CKD.
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Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Zoghbi WA, Arend TE, Oetgen WJ, May C, Bradfield L, Keller S, Ramadhan E, Tomaselli GF, Brown N, Robertson RM, Whitman GR, Bezanson JL, Hundley J. 2012 ACCF/AHA Focused Update Incorporated Into the ACCF/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction. Circulation 2013; 127:e663-828. [DOI: 10.1161/cir.0b013e31828478ac] [Citation(s) in RCA: 181] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Jneid H, Ettinger SM, Ganiats TG, Philippides GJ, Jacobs AK, Halperin JL, Albert NM, Creager MA, DeMets D, Guyton RA, Kushner FG, Ohman EM, Stevenson W, Yancy CW. 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 61:e179-347. [PMID: 23639841 DOI: 10.1016/j.jacc.2013.01.014] [Citation(s) in RCA: 373] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Dohi T, Kasai T, Miyauchi K, Takasu K, Kajimoto K, Kubota N, Amano A, Daida H. Prognostic impact of chronic kidney disease on 10-year clinical outcomes among patients with acute coronary syndrome. J Cardiol 2012; 60:438-42. [PMID: 23063662 DOI: 10.1016/j.jjcc.2012.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 07/21/2012] [Accepted: 08/13/2012] [Indexed: 02/01/2023]
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Marenzi G, Cabiati A, Assanelli E. Chronic kidney disease in acute coronary syndromes. World J Nephrol 2012; 1:134-45. [PMID: 24175251 PMCID: PMC3782212 DOI: 10.5527/wjn.v1.i5.134] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Revised: 08/20/2012] [Accepted: 09/25/2012] [Indexed: 02/06/2023] Open
Abstract
Chronic kidney disease (CKD) is associated with a high burden of coronary artery disease. In patients with acute coronary syndromes (ACS), CKD is highly prevalent and associated with poor short- and long-term outcomes. Management of patients with CKD presenting with ACS is more complex than in the general population because of the lack of well-designed randomized trials assessing therapeutic strategies in such patients. The almost uniform exclusion of patients with CKD from randomized studies evaluating new targeted therapies for ACS, coupled with concerns about further deterioration of renal function and therapy-related toxic effects, may explain the less frequent use of proven medical therapies in this subgroup of high-risk patients. However, these patients potentially have much to gain from conventional revascularization strategies used in the general population. The objective of this review is to summarize the current evidence regarding the epidemiology and the clinical and prognostic relevance of CKD in ACS patients, in particular with respect to unresolved issues and uncertainties regarding recommended medical therapies and coronary revascularization strategies.
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Affiliation(s)
- Giancarlo Marenzi
- Giancarlo Marenzi, Angelo Cabiati, Emilio Assanelli, Centro Cardiologico Monzino, IRCCS Department of Cardiovascular Sciences, University of Milan, 20138 Milan, Italy
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Coronary plaque composition, morphology, and outcomes in patients with and without chronic kidney disease presenting with acute coronary syndromes. JACC Cardiovasc Imaging 2012; 5:S53-61. [PMID: 22421231 DOI: 10.1016/j.jcmg.2011.12.008] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 12/16/2011] [Accepted: 12/30/2011] [Indexed: 01/26/2023]
Abstract
OBJECTIVES This study sought to evaluate the impact of chronic kidney disease (CKD) on coronary atherosclerotic plaque composition, morphology, and outcomes in patients with acute coronary syndromes (ACS). BACKGROUND CKD patients presenting with ACS are at increased risk for adverse events. Whether or not this increased risk reflects differences in coronary plaque composition remains unknown. METHODS In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, patients presenting with ACS in whom percutaneous coronary intervention was successful underwent 3-vessel grayscale and radiofrequency intravascular ultrasound imaging. Lesions were prospectively characterized, and patients were followed for a median of 3.4 years. We conducted a patient-level and lesion-level analysis of study participants by comparing intravascular ultrasound parameters of untreated nonculprit lesions in patients with and without CKD. RESULTS Patients with CKD (n = 73, 11.3%) were older, more often female and diabetic compared to those without CKD (n = 573). Nonculprit lesions in patients with (n = 280) versus without (n = 2,390) CKD were more likely to have plaque burden ≥ 70% (11.8% vs. 8.5%, p = 0.05) and minimal luminal area ≤ 4.0 mm(2) (25.9% vs. 19.2%, p = 0.005). The percentage of plaque comprised of necrotic core (15.0% vs. 13.0%, p = 0.0001) and dense calcium (8.2% vs. 6.4%, p < 0.0001) was higher while fibrous tissue (57.7% vs. 59.8%, p < 0.0001) was lower in CKD versus non-CKD lesions. The 3-year composite rate of cardiac death, cardiac arrest, or myocardial infarction (15.1% vs. 3.3%, p < 0.0001) was significantly higher in patients with than in those without CKD, although there were no differences in the rates of events adjudicated to nonculprit lesions. CONCLUSIONS Following percutaneous coronary intervention of all culprit lesions in ACS, patients with versus without CKD have more extensive and severe atherosclerosis remaining in their coronary tree with plaque composed of greater necrotic core and less fibrous tissue. These influences resulted in nonsignificantly different rates of non-culprit lesion-related adverse events, although cardiac death, arrest, or myocardial infarction were more common in patients with CKD.
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Wagner M, Schilling R, Doeblin P, Huppertz A, Luhur R, Schwenke C, Maurer M, Hamm B, Taupitz M, Durmus T. Macrocyclic contrast agents for magnetic resonance imaging of chronic myocardial infarction: intraindividual comparison of gadobutrol and gadoterate meglumine. Eur Radiol 2012; 23:108-14. [DOI: 10.1007/s00330-012-2563-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 05/18/2012] [Accepted: 05/24/2012] [Indexed: 01/25/2023]
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Gadobutrol for magnetic resonance imaging of chronic myocardial infarction: intraindividual comparison with gadopentetate dimeglumine. Invest Radiol 2012; 47:183-8. [PMID: 22183078 DOI: 10.1097/rli.0b013e318236e354] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To compare 0.15 mmol/kg gadobutrol with 0.20 mmol/kg gadopentetate dimeglumine with regard to late gadolinium enhancement (LGE) of infarcted myocardium at magnetic resonance (MR) imaging. MATERIALS AND METHODS Twenty patients with history of chronic myocardial infarction underwent 2 cardiac MR examinations at 1.5 Tesla. For the evaluation of myocardial infarction, late gadolinium enhancement (LGE) imaging was performed with an inversion recovery-prepared gradient-echo sequence 15 minutes after administration of either gadobutrol (r1 = 5.2 mmol(-1)s(-1)) or gadopentetate dimeglumine (r1 = 4.1 mmol(-1)s(-1)). The dose of the contrast agents was adjusted based on the relaxivity of both contrast agents. Hence, gadobutrol and gadopentetate dimeglumine were administered at 0.15 mmol/kg and 0.20 mmol/kg, respectively. Contrast-to-noise ratios (CNR) between infarcted myocardium and remote myocardium (CNR remote) and between infarcted myocardium and left ventricular lumen (CNR lumen) were assessed by 2 independent readers. Additionally, infarct size was assessed semiautomatically by using a threshold of 5 standard deviations above the mean signal intensity of remote myocardium. RESULTS Subendocardial or transmural LGE was present in 16 of 20 (80%) patients. The optimal inversion time for LGE imaging did not differ significantly between gadobutrol and gadopentetate dimeglumine (275 ± 21 milliseconds [range, 240-320 milliseconds] and 282 ± 23 milliseconds [range, 240-330 milliseconds], respectively; P = 0.32). The CNR remote after administration of gadobutrol (40.0 ± 4.6; 95% confidence interval [CI]: 30.3; 49.7) and gadopentetate dimeglumine (40.6 ± 4.6; 95% CI: 30.9; 50.3) did not show significant differences (P = 0.90), whereas gadobutrol yielded a significantly higher CNR lumen (6.2 ± 3.6; 95% CI: -1.5; 13.9) compared with gadopentetate dimeglumine (0.8 ± 3.6; 95% CI: -6.9; 8.5). Infarct size after administration of gadobutrol (23.7 ± 4.7 mL; 95% CI: 13.6; 33.7) and gadopentetate dimeglumine (23.7 ± 4.7 mL;95% CI: 13.7; 33.8) was not statistically different (P = 0.94). There was an excellent correlation between gadobutrol- and gadopentetate dimeglumine-enhanced assessment of infarct size (Spearman r = 0.99 and r = 0.97 for reader 1 and 2, respectively). CONCLUSION This pilot study shows that 0.15 mmol/kg gadobutrol is an effective contrast agent for LGE imaging with better delineation of infarcted myocardium from left ventricular lumen than 0.20 mmol/kg gadopentetate dimeglumine.
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AlFaleh HF, Alsuwaida AO, Ullah A, Hersi A, AlHabib KF, AlNemer K, AlSaif S, Taraben A, Kashour T, Balghith MA, Ahmed WH. The prognostic impact of in-hospital worsening of renal function in patients with acute coronary syndrome. Int J Cardiol 2012; 167:866-70. [PMID: 22349044 DOI: 10.1016/j.ijcard.2012.01.097] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 01/08/2012] [Accepted: 01/28/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Renal impairment is strongly linked to adverse cardiovascular (CV) events. Baseline renal dysfunction is a strong predictor of CV mortality and morbidity in patients admitted with acute coronary syndrome (ACS). However, the prognostic importance of worsening renal function (WRF) in these patients is not well characterized. METHODS ACS patients enrolled in the SPACE (Saudi Project for Assessment of Coronary Events) registry who had baseline and pre-discharge serum creatinine data available were eligible for this study. WRF was defined as a 25% reduction from admission estimated glomerular filtration rate (eGFR) within 7 days of hospitalization. Baseline demographics, clinical presentation, therapies, and in-hospital outcomes were compared. RESULTS Of the 3583 ACS patients, WRF occurred in 225 patients (6.3%), who were older, had more cardiovascular risk factors, were more likely to be female, have past vascular disease, and presented with more non-ST-segment elevation myocardial infarction than patients without WRF (39.5% vs. 32.8%; p=0.042). WRF was associated with an increased risk of in-hospital death, heart failure, cardiogenic shock, and stroke. After adjusting for potential confounders, WRF was an independent predictor of in-hospital death (adjusted odd ratio 28.02, 95% CI 13.2-60.28, p<0.0001). WRF was more predictive of mortality than baseline eGFR. CONCLUSION These results indicate that WRF is a powerful predictor for in-hospital mortality and CV complications in ACS patients.
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Affiliation(s)
- Hussam F AlFaleh
- Cardiac Sciences Department, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
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Young Altahan R, Goldenberg I, Kimron L, Barsheshet A, Guetta V. Timing of coronary angiography and outcome in patients with non-ST elevation acute coronary syndromes and kidney disease: real-world data from the acute coronary syndromes Israeli survey. Cardiology 2011; 119:224-34. [PMID: 22041637 DOI: 10.1159/000332588] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 08/26/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Patients with kidney disease (KD) who present with non-ST segment elevation acute coronary syndromes (NSTE-ACS) may benefit from coronary intervention. We evaluated the outcome of these patients who were referred for early or late coronary angiography. METHODS The risk of 1-year mortality according to the presence of KD [estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2)] and the time of coronary angiography [categorized as early (≤48 h from admission) or late (>48 h from admission)] was assessed among 2,001 NSTE-ACS patients enrolled in the ACS Israeli Survey between 2004 and 2008. A propensity score for early angiography was included in the proportional hazards modeling of mortality. RESULTS Patients with KD (n = 729) experienced a 2.7-fold increased risk of death compared with non-KD patients (p < 0.001). Early coronary angiography was associated with a lower rate of in-hospital complications and 30-day mortality. Both early and late angiography were associated with a lower adjusted risk of 1-year mortality [hazard ratios (HRs) 0.46 (p < 0.001) and 0.59 (p = 0.002), respectively] compared with no angiography. In patients with severe KD (eGFR <30 ml/min/1.73 m(2)), only early coronary angiography was associated with a lower mortality risk (HR 0.25, 95% confidence interval 0.08-0.81). CONCLUSIONS An early invasive strategy is associated with a low mortality risk in NSTE-ACS patients with KD and a more pronounced effect among those with severe KD.
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Wright RS, Anderson JL, Adams CD, Bridges CR, Casey DE, Ettinger SM, Fesmire FM, Ganiats TG, Jneid H, Lincoff AM, Peterson ED, Philippides GJ, Theroux P, Wenger NK, Zidar JP, Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Zidar JP. 2011 ACCF/AHA focused update incorporated into the ACC/AHA 2007 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the American Academy of Family Physicians, Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons. J Am Coll Cardiol 2011; 57:e215-367. [PMID: 21545940 DOI: 10.1016/j.jacc.2011.02.011] [Citation(s) in RCA: 301] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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AlFaleh HF, Alsuwaida AO, Ullah A, Hersi A, AlHabib KF, AlShahrani A, AlNemer K, AlSaif S, Taraben A, Ahmed WH, Balghith MA, Kashour T. Glomerular filtration rate estimated by the CKD-EPI formula is a powerful predictor of in-hospital adverse clinical outcomes after an acute coronary syndrome. Angiology 2011; 63:119-26. [PMID: 21602255 DOI: 10.1177/0003319711409565] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The prognostic value of admission estimated glomerular filtration rate (eGFR) calculated by the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula for cardiovascular adverse outcomes in acute coronary syndrome (ACS) was explored. Baseline eGFR was classified as no renal dysfunction (>90 mL/min per 1.73 m(2)), borderline (90-60.1 mL/min per 1.73 m(2)), moderate (60-30.1 mL/min per 1.73 m(2)), or severe (≤30 mL/min per 1.73 m(2)) renal dysfunction. Of the 5034 patients, 3415 (67.8%) had eGFR <90. Compared to patients with an eGFR ≥60 mL/min per 1.73 m(2), patients with <60 mL/min per 1.73 m(2) were less likely to be treated with β-blockers, angiotensin-converting enzyme inhibitors, or statins, or to undergo percutaneous coronary interventions. Lower eGFR showed a stepwise association with significantly worse adverse in-hospital outcomes. The adjusted odds ratio of in-hospital death with an eGFR <30 mL/min per 1.73 m(2) was 3.1 (95% confidence interval 1.1-8.4, P = .0324), compared with an eGFR >90 mL/min per 1.73 m(2). Estimated glomerular filtration rate calculated by the new CKD-EPI is an independent predictor of major adverse cardiac outcomes in patients with ACS.
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Affiliation(s)
- Hussam F AlFaleh
- Department of Cardiac Sciences, College of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia.
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Vogel B, Hahne S, Kozanli I, Kalla K, Jarai R, Freynhofer M, Smetana P, Nürnberg M, Geppert A, Unger G, Huber K. Influence of updated guidelines on short- and long-term mortality in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Int J Cardiol 2011; 159:198-204. [PMID: 21447430 DOI: 10.1016/j.ijcard.2011.02.073] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Revised: 01/17/2011] [Accepted: 02/25/2011] [Indexed: 12/01/2022]
Abstract
AIM In 2002 the ACC/AHA guidelines for the management of patients with unstable angina (UA) and non-ST-segment elevation myocardial infarction (NSTEMI) were updated. We aimed to answer whether the implementation of updated guidelines was capable of influencing short- and long-term mortality in these patients. METHODS We analyzed data on 812 consecutive patients who were admitted with either UA or NSTEMI between 2001 and 2004. Patients admitted in the two years before the implementation of updated guidelines (UA(01/02) group and NSTEMI(01/02) group) were compared to patients admitted in the two years thereafter (UA(03/04) group and NSTEMI(03/04) group). Yearly follow-up concerning all-cause mortality was obtained up to four years. RESULTS The rate of revascularizations, the percentage of procedures performed within 48 h of admission, and the administration of clopidogrel increased significantly. However, still many - especially high-risk - patients did not receive revascularization. Patients of both UA groups had an identical in-hospital mortality rate. Differences in mortality between groups gained statistical significance over time (four-year mortality; 15.1% for the UA(03/04) group vs. 26.5% for the UA(01/02) group, p=0.014; HR 0.49 95% CI 0.28-0.87). In patients with NSTEMI in-hospital mortality decreased from 18.4% in the NSTEMI(01/02) group to 9.6% in the NSTEMI(03/04) group (p=0.011; HR 0.47 95% CI 0.26-0.84), and 1-year mortality from 34.7% to 25.1% (p=0.038; HR 0.63 95% CI 0.41-0.98), respectively. Mortality rates beyond one year were still lower in the NSTEMI(03/04) group as compared to the NSTEMI(01/02) group but it did not reach statistical significance. Multivariate Cox-regression analysis revealed furthermore that also patients with higher age and/or renal dysfunction benefit from an early invasive strategy. CONCLUSION The implementation of updated guidelines for NSTE-ACS had significant impact on short- and long-term mortality. However, an early invasive strategy is still withheld to a significant number of high-risk patients, who would benefit from an invasive treatment.
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Affiliation(s)
- B Vogel
- 3rd Department Medicine, Cardiology and Emergency Medicine, Wilhelminen Hospital, Montleartstrasse 37, 1160 Vienna, Austria.
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Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Smith SC. 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 123:e426-579. [PMID: 21444888 DOI: 10.1161/cir.0b013e318212bb8b] [Citation(s) in RCA: 349] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Wetmore JB, Sankaran S, Jones PG, Reid KJ, Spertus JA. Association of decreased glomerular filtration rate with racial differences in survival after acute myocardial infarction. Clin J Am Soc Nephrol 2011; 6:733-40. [PMID: 21310822 DOI: 10.2215/cjn.02030310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES African-American race and decreased kidney function have been associated with higher mortality after acute myocardial infarction (AMI). However, whether there are racial differences in the prevalence or prognostic importance of renal insufficiency in AMI is unknown. DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS Among 1847 AMI patients enrolled in the multicenter Prospective Registry Evaluating Myocardial Infarction Event and Recovery (PREMIER) study, estimated glomerular filtration rate (eGFR) was used to stratify prognosis and to examine potential interactions among eGFR, race, and mortality. Multivariable proportional hazards regression was used to examine the effect of race and eGFR on 3.5-year all-cause mortality. RESULTS Race and eGFR were significantly associated with mortality. After adjustment for eGFR alone, differences in mortality by race were substantially attenuated (unadjusted hazard ratio [HR] for African Americans=1.56 [95% confidence interval {CI}=1.2 to 2.1]; eGFR-adjusted HR=1.32 [95% CI=0.99 to 1.75]). A similar magnitude of attenuation in racial differences in survival was observed after adjustment for all covariates except eGFR (HR=1.29 [95% CI=0.96 to 1.72]). A final model adjusting for all covariates only slightly attenuated the association further. No interaction between race and eGFR was detected. CONCLUSIONS Renal insufficiency, which may represent chronic kidney disease, is a prognostically important comorbidity in African Americans after AMI. However, the effect of decreased eGFR on mortality is comparable between races, suggesting that preventing renal insufficiency in African Americans could be an important target to reduce racial disparities in post-AMI survival.
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Affiliation(s)
- James B Wetmore
- Division of Nephrology, Department of Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA
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Dohi T, Miyauchi K, Okazaki S, Yokoyama T, Tamura H, Kojima T, Yokoyama K, Kurata T, Daida H. Long-term impact of mild chronic kidney disease in patients with acute coronary syndrome undergoing percutaneous coronary interventions. Nephrol Dial Transplant 2011; 26:2906-11. [DOI: 10.1093/ndt/gfq820] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Berger PB, Best PJM. Does kidney function alter the benefit of reperfusion therapy for ST-segment elevation myocardial infarction? JACC Cardiovasc Interv 2010; 2:34-6. [PMID: 19463395 DOI: 10.1016/j.jcin.2008.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Accepted: 09/29/2008] [Indexed: 10/21/2022]
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Uren N. Acute coronary syndromes: assessing risk and choosing optimal pharmacological regimens for a superior outcome. Eur Heart J Suppl 2010. [DOI: 10.1093/eurheartj/suq020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Insulin resistance and acute coronary syndrome. Atherosclerosis 2010; 211:672-5. [DOI: 10.1016/j.atherosclerosis.2010.03.033] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 02/07/2010] [Accepted: 03/25/2010] [Indexed: 11/20/2022]
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Tsai TT, Nallamothu BK. Percutaneous coronary intervention in patients with chronic kidney disease: where’s the evidence? Interv Cardiol 2010. [DOI: 10.2217/ica.10.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Brown A. Acute coronary syndromes in indigenous Australians: opportunities for improving outcomes across the continuum of care. Heart Lung Circ 2010; 19:325-36. [PMID: 20363187 DOI: 10.1016/j.hlc.2010.02.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Amongst a long list of health issues driving the disparity experienced by Indigenous Australians, cardiovascular disease (CVD) remains the primary target. It is the principal cause of death and of excess death among Indigenous people in Australia, and accounts for almost one-third of the life expectancy gap. Most attention has focused on the higher burden of traditional risk factors experienced by Indigenous people to explain CVD disparity. Far less attention has focused on the quality and outcomes of health system performance in explaining these differentials. The CASPA study was a retrospective, mixed-methods clinical registry and quality improvement program established in the NT of Australia, focused on the patterns, burdens, provision of care, experience of services, adverse outcomes and their determinants among 492 patients (214 Indigenous and 278 non-Indigenous). RESULTS Indigenous patients were significantly younger and more likely to have existing CVD risk factors and co-morbid chronic disease. During hospitalisation they received similar rates of evidence-based care with the exception of lower rates of diagnostic angiography (36.2% vs. 47.6%, p=0.012), lower rates of in-patient cardiac rehabilitation (8.9% vs. 15.3%, p=0.03) and lower prescription of discharge statin (44.8% vs. 57.8%, p=0.006). Indigenous patients were more likely to die during two years of follow-up (30% vs. 17.8%, p=0.002). Both Indigenous and non-Indigenous patients were similarly under-prescribed evidence based therapy after discharge. Exploratory qualitative examination of the experience of Indigenous patients in Alice Springs identified significant barriers to care across the continuum. CONCLUSION Improvements in the delivery of known effective therapies will make a significant impact on adverse outcomes in Indigenous and non-Indigenous patients alike. Comprehensive and sustained prospective data collection to compliment system reform is essential to improve outcomes and reduce disparity in CVD outcomes experienced by Indigenous Australians.
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Affiliation(s)
- Alex Brown
- Centre for Indigenous Vascular and Diabetes Research, BakerIDI Heart and Diabetes Institute, Alice Springs, NT, Australia.
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El-Menyar A, Zubaid M, Sulaiman K, Singh R, Al Thani H, Akbar M, Bulbanat B, Al-Hamdan R, AlMahmmed W, Al Suwaidi J. In-hospital major clinical outcomes in patients with chronic renal insufficiency presenting with acute coronary syndrome: data from a Registry of 8176 patients. Mayo Clin Proc 2010; 85:332-40. [PMID: 20360292 PMCID: PMC2848421 DOI: 10.4065/mcp.2009.0513] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the impact of chronic renal insufficiency (CRI) on in-hospital major adverse cardiac events across the acute coronary syndrome (ACS) spectrum. PATIENTS AND METHODS From January 29, 2007, through July 29, 2007, 6 adjacent Middle Eastern countries participated in the Gulf Registry of Acute Coronary Events, a prospective, observational registry of 8176 patients. Patients were categorized according to estimated glomerular filtration rate into 4 groups: normal (>or=90 mL/min), mild (60-89 mL/min), moderate (30-59 mL/min), and severe CRI (<30 mL/min). Patients' characteristics and in-hospital major adverse cardiac events in the 4 groups were analyzed. RESULTS Of 6518 consecutive patients with ACS, 2828 (43%) had mild CRI, 1304 (20%) had moderate CRI, and 345 (5%) had severe CRI. In CRI groups, patients were older and had a higher prevalence of hypertension, diabetes mellitus, and dyslipidemia. On admission, these patients had a higher resting heart rate and frequently had atypical and delayed presentations. Compared with the normal estimated glomerular filtration group, CRI groups were less likely to receive antiplatelet drugs, beta-blockers, angiotensin-converting enzyme inhibitors, and statins and were less likely to undergo coronary angiography. In-hospital heart failure, cardiogenic shock, and major bleeding episodes were significantly higher in all CRI groups. In multivariate analysis, mild, moderate, and severe CRI were associated with a higher adjusted odds ratio (OR) of death (mild: OR, 2.1; 95% confidence interval [CI], 1.2-3.7; moderate: OR, 6.7; 95% CI, 3.9-11.5; and severe: OR, 12.0; 95% CI, 6.6-21.7). CONCLUSION Across the ACS spectrum, patients with CRI had a worse risk profile, had more atypical and delayed presentations, and were less likely to receive evidence-based therapy. Chronic renal insufficiency of varying stages is an independent predictor of in-hospital morbidity and mortality.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jassim Al Suwaidi
- Individual reprints of this article are not available. Address correspondence to Jassim Al Suwaidi, MBChB, Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital (HMC), PO Box 3050, Doha, Qatar ()
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Tödt T, Sederholm-Lawesson S, Stenestrand U, Alfredsson J, Janzon M, Swahn E. Early treatment with abciximab in patients with ST elevation myocardial infarction results in a high rate of normal or near normal blood flow in the infarct related artery. ACUTE CARDIAC CARE 2010; 12:10-7. [PMID: 20201657 DOI: 10.3109/17482940903505926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED There is debate whether early treatment with GpIIb/IIIa inhibitors is of clinical benefit in primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). This study explored the effects of early given abciximab on coronary blood flow and major adverse cardiac events (MACE) in patients with STEMI treated with primary PCI and adjunctive abciximab. We studied all consecutive patients from our catchment area with STEMI undergoing acute angiography with the intention of primary PCI during 2005. Abciximab was given as early pre-treatment before, (n = 133) or at the cath. lab. after a diagnostic angiography (n = 109). Pre-procedural TIMI 2-3 flow was observed in 45.9 % of patients in the early group versus 20.2 % in the cath. lab. group, P = 0.0001. Mortality rates were 3.8 % versus 3.7% inhospital and 8.3 % versus 7.3% at one year in the early respectively the cath. lab. group, both P = NS. The MACE rate (death, non fatal myocardial infarction, unplanned revascularization) at one year was 19.5 % (early group) and 26.6 % (cath. lab. group), P = 0.19. CONCLUSION In this single centre registry study of unselected patients with STEMI early given abciximab was associated with a significantly higher rate of TIMI 2-3 flow compared to abciximab given after the acute angiography.
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Affiliation(s)
- Tim Tödt
- Department of Medical and Health Sciences, Division of Cardiovascular Medicine, Linköping University, and Heart Center, Linköping University Hospital, Linköping, Sweden.
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Increased mortality among survivors of myocardial infarction with kidney dysfunction: the contribution of gaps in the use of guideline-based therapies. BMC Cardiovasc Disord 2009; 9:29. [PMID: 19586550 PMCID: PMC2716301 DOI: 10.1186/1471-2261-9-29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 07/08/2009] [Indexed: 11/16/2022] Open
Abstract
Background We assessed the degree to which differences in guideline-based medical therapy for acute myocardial infarction (AMI) contribute to the higher mortality associated with kidney disease. Methods In the PREMIER registry, we evaluated patients from 19 US centers surviving AMI. Cox regression evaluated the association between estimated glomerular filtration rate (GFR) and time to death over two years, adjusting for demographic and clinical variables. The contribution of variation in guideline-based medical therapy to differences in mortality was then assessed by evaluating the incremental change in the hazard ratios after further adjustment for therapy. Results Of 2426 patients, 26% had GFR ≥ 90, 44% had GFR = 60- < 90, 22% had GFR = 30- < 60, and 8% had GFR < 30 ml/min/1.73 m2. Greater degrees of renal dysfunction were associated with greater 2-year mortality and lower rates of guideline-based therapy among eligible patients. For patients with severely decreased GFR, adjustment for differences in guideline-based therapy did not significantly attenuate the relationship with mortality (HR 3.82, 95% CI 2.39–6.11 partially adjusted; HR = 3.90, 95% CI 2.42–6.28 after adjustment for treatment differences). Conclusion Higher mortality associated with reduced GFR after AMI is not accounted for by differences in treatment factors, underscoring the need for novel therapies specifically targeting the pathophysiological abnormalities associated with kidney dysfunction to improve survival.
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