Impact of Optimal Medical Therapy and Revascularization on Outcome of Patients With Chronic Kidney Disease and on Dialysis Who Presented With Acute Coronary Syndrome

Laurent Bonello, Axel De Labriolle, Probal Roy, Daniel H. Steinberg, Teruo Okabe, T. L P Slottow, Zhenyi Xue, Rebecca Torguson, William O. Suddath, Lowell F. Satler, Kenneth M. Kent, Augusto D. Pichard, Joseph Lindsay, Ron Waksman*

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    40 Citations (Scopus)

    Abstract

    Coronary artery disease is the main cause of death in patients with chronic kidney disease (CKD). The poor prognosis associated with acute coronary syndrome (ACS) in these patients has been related to therapeutic nihilism. This study included 2,357 patients with ACS who had percutaneous coronary intervention. According to their creatinine clearance and medical history, they were divided into 3 groups: dialysis (n = 73); CKD (n= 293); and control (n= 1,991). Rates of cardiovascular events were recorded during a 1-year follow-up period. Patients in all groups received similar contemporary therapy for ACS, including percutaneous coronary intervention and optimal medial therapy. On admission, patients with CKD and patients on dialysis more often presented with cardiogenic shock (p = 0.05 and 0.02, respectively). A graded increase in the rate of major adverse cardiovascular events at 1 year was observed with decreasing renal function (control 13%, CKD 22.9%, dialysis 45.2%, p <0.001 for all comparisons). In multivariate analysis, patients with CKD and on dialysis were significantly associated with 1-year major adverse cardiac events with adjusted hazard ratios of, respectively, 1.5 (95% confidence interval 1.1 to 2.1; p = 0.009) and 2.7 (95% confidence interval 1.7 to 4.1; p <0.001). In conclusion, despite optimal contemporary medical therapy and revascularization, the prognosis of patients with CKD and, in particular, of patients undergoing dialysis, remains poor.

    Original languageEnglish
    Pages (from-to)535-540
    Number of pages6
    JournalAmerican Journal of Cardiology
    Volume102
    Issue number5
    DOIs
    Publication statusPublished - 1 Sep 2008

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