Patients with chronic kidney disease (CKD) are less likely than those without CKD to undergo invasive procedures for acute coronary syndrome (ACS) even though such treatment is associated with decreased mortality, according to study findings presented at the National Kidney Foundation’s Spring Clinical Meetings in Boston, Massachusetts.
The study included 2794 patients hospitalized with ACS from January 1, 2016 to December 31, 2019. Of these, 540 had CKD (patients with stage 5 or end-stage kidney disease were excluded) and 2254 did not. In adjusted analyses, the CKD group had 32% lower odds of having an invasive cardiac procedure (ie, coronary angiography/percutaneous coronary intervention or coronary artery bypass grafting) compared with the no-CKD group, Sanjana Kapoor, MD, and Steven Weisbord, MD, MSc, of the University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania, reported. The investigators adjusted for age, race, gender, and history of diabetes, hypertension, and cardiovascular accident (CVA).
Cardiovascular procedures were associated with decreased 5-year mortality risk in both groups, but to a greater extent in the no-CKD group. The patients with and without CKD who underwent the procedures had a significant 37% and 58% decreased risk for death at 5 years, respectively, compared with patients who did not undergo the procedures, Drs Kapoor and Weisbord reported in a poster presentation.
The study cohort included 2316 patients with non-ST-elevation myocardial infarction (NSTEMI) and 478 with STEMI. The CKD group was significantly older than the no-CKD group (mean 78.1 vs 70.5 years) and had significantly higher proportions of patients with hypertension (98% vs 90%), diabetes (67.2% vs 42.3%), and history of CVA (34.6% vs 21.0%).
“In a contemporaneous cohort of patients treated at a large, academic, tertiary-referral hospital system, patients with CKD are less likely to undergo invasive care to treat ACS, despite a decrease in mortality with such treatment,” Drs Kapoor and Weisbord concluded.
Kapoor S, Weisbord S. Lower utilization of invasive cardiac care in patients with stage 3 and 4 chronic kidney disease (CKD) admitted with acute coronary syndrome in a tertiary healthcare system. Presented at the National Kidney Foundation’s 2022 Spring Clinical Meetings, Boston, Massachusetts, April 6-10, 2022. Poster 182.