Early Invasive Strategy and Outcome of Non–ST-Segment Elevation MI Patients With CKD

The long-term survival of non–ST-segment elevation myocardial infarction (NSTEMI) patients with chronic kidney disease (CKD) did not increase with early invasive strategy as per a recent study that was published in the JACC: Cardiovascular Interventions. 

The early invasive strategy should be considered for the treatment of non–ST-segment elevation myocardial infarction (NSTEMI) patients. But most of NSTEMI patients have chronic kidney disease (CKD) and there is an uncertainty of data regarding the management of NSTEMI patients with CKD. Hence researchers conducted a study to evaluate the association between early invasive strategy and long-term survival among patients with NSTEMI and CKD. 

A retrospective analysis of 7,107 consecutive NSTEMI patients was done between 2008 and 2021. Patients were divided based on kidney function into early (≤24 hours) and delayed invasive groups. Inverse probability treatment weighting was used to adjust for differences in baseline characteristics. The primary outcome was all-cause mortality. 

Results

• 3,529 invasively treated patients with a median age of 66 years (IQR: 58-74 years) participated in the study.
• Out of the total, 1,837 (52%) were treated early.
• There were 483 (14%) patients with at least moderate CKD having an estimated glomerular filtration rate [eGFR] <45 mL/min/1.73 m2.
• During a median follow-up of 4 years, 527 (15%) patients died.
• An early invasive strategy was associated with a significantly 30% lower mortality compared with a delayed strategy after applying the inverse probability treatment weighting. 
• The association between early invasive strategy and mortality was modified by eGFR and declined with lower renal function, with no difference in mortality among patients with eGFR <45 mL/min/1.73 m2. 

The study shows that CKD is a modifying factor for using an early invasive strategy in NSTEMI patients. Long-term survival did not increase in NSTEMI patients with CKD despite the early invasive strategy. 

Further reading: Sharon A, Massalha E, Fishman B, et al. Early Invasive Strategy and Outcome of Non–ST-Segment Elevation Myocardial Infarction Patients With Chronic Kidney Disease. J Am Coll Cardiol Intv. 2022 Oct, 15 (19) 1977-1988. https://doi.org/10.1016/j.jcin.2022.08.008