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