Long-term prognosis of chronic kidney disease in non-ST elevation acute coronary syndrome treated with invasive strategy

Abstract

Background and aim: Patients with chronic kidney disease (CKD) have an increased risk of adverse cardiovascular outcomes after non-ST elevation acute coronary syndrome (NSTE-ACS). However, the information available on this specific population is scarce. We evaluate the impact of CKD on long-term prognosis in patients with NSTE-ACS managed with invasive strategy. Methods: We conduct a prospective registry of patients with NSTE-ACS and coronary angiography. CKD was defined as a glomerular filtration rate <60 ml/min/1.73 m2. The composite primary end-point was cardiac death and non-fatal cardiovascular readmission. We estimated the cumulative probability and hazard rate (HR) of combined primary end-point at 3 years according to the presence or absence of CKD. Results: We included 248 patients with mean age of 66.9 years, 25% women. CKD was present at baseline in 67 patients (27%). Patients with CKD were older (74.9 vs. 63.9 years; p < 0.0001) with more prevalence of hypertension (89.6 vs. 66.3%; p < 0.0001), diabetes (53.7 vs. 35.9%; p = 0.011), history of heart failure (13.4 vs. 3.9%; p = 0.006) and anemia (47.8 vs. 16%; p < 0.0001). No differences in the extent of coronary artery disease. CKD was associated with higher cumulative probability (49.3 vs. 28.2%; log-rank p = 0.001) and HR of the primary combined end-point (HR: 1.94; 95% CI: 1.12–3.27; p = 0.012). CKD was an independent predictor of adverse cardiovascular outcomes at 3 years (HR: 1.66; 95% CI: 1.05–2.61; p = 0.03). Conclusions: In NSTE-ACS patients treated with invasive strategy, CKD is associated independently with an increased risk of adverse cardiovascular outcomes at 3 years.

Keywords

• Chronic kidney disease
• Acute coronary syndrome
• Prognosis
• Invasive management