As expected, the in-hospital mortality was somewhat lower for the non-ST-elevation MI population (compared with those with non-ST-elevation MI), with a range of 1.8% to 13.4%., with CKD patients 2.1 to 4.0 times more likely to die than non-CKD patients.

Regardless of the MI type, patients with CKD were less likely to receive acute aspirin, beta blockers, or clopidogrel, Dr. Wiviott said.

Among patients with ST-elevation MI, 98% without CKD received aspirin acutely. “As we move up the CKD grades, there was progressively lower use of aspirin,” he said. The same trend was apparent for patients with non-ST-elevation MI.


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Percutaneous coronary intervention (PCI) in patients with ST-elevation MI was performed in 85% of patients without CKD and less so as CKD severity increased, such that only 45% of patients with stage 5 CKD underwent PCI. Similar trends for PCI were observed in those with non-ST-elevation MI.

“The rates of major bleeding were 40% to 60% higher in those with CKD,” Dr. Wiviott said.

At discharge, there was significantly lower utilization of aspirin, clopidogrel, statins, and beta blockers in CKD patients compared with non-CKD patients, and utilization was progressively worse as CKD stage increased. Even counseling about exercise and diet was less in CKD patients, he said.

The reason for the difference in outcomes between the CKD and non-CKD patients “is probably multifactorial as to whether this is withholding evidence-based therapy or whether it’s the baseline risk of these patients with CKD,” he said.

“It’s probably both. There’s no individual therapy that I’m aware of that results in 30% to 40% reductions in mortality, so even if they were given uniformly in one group and not at all in another group, you would not expect to see these gradients.”