Inpatient Coronary Angiography and Revascularisation following Non-ST-Elevation Acute Coronary Syndrome in Patients with Renal Impairment: A Cohort Study Using the Myocardial Ischaemia National Audit Project

Catriona Shaw*, Dorothea Nitsch, Retha Steenkamp, Cornelia Junghans, Sapna Shah, Donal O'Donoghue, Damian Fogarty, Clive Weston, Claire C. Sharpe

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    12 Citations (Scopus)

    Abstract

    Background: International guidelines support an early invasive management strategy (including early coronary angiography and revascularisation) for non-ST-elevation acute coronary syndrome (NSTE-ACS) in patients with renal impairment. However, evidence from outside the UK suggests that this approach is underutilised. We aimed to describe practice within the NHS, and to determine whether the severity of renal dysfunction influenced the provision of angiography and modified the association between early revascularisation and survival.

    Methods: We performed a cohort study, using multivariable logistic regression and propensity score analyses, of data from the Myocardial Ischaemia National Audit Project for patients presenting with NSTE-ACS to English or Welsh hospitals between 2008 and 2010.

    Findings: Of 35 881 patients diagnosed with NSTE-ACS, eGFR of

    Interpretation: Early revascularisation may offer a similar survival benefit in patients with and without renal dysfunction, yet renal impairment is an important determinant of the provision of coronary angiography following NSTE-ACS. A randomised controlled trial is needed to evaluate the efficacy of an early invasive approach in patients with severe renal dysfunction to ensure that all patients who may benefit are offered this treatment option.

    Original languageEnglish
    Article numbere99925
    Number of pages11
    JournalPL o S One
    Volume9
    Issue number6
    DOIs
    Publication statusPublished - 17 Jun 2014

    Keywords

    • CHRONIC KIDNEY-DISEASE
    • CONSERVATIVE MANAGEMENT
    • HEART-DISEASE
    • INFARCTION
    • OUTCOMES
    • RISK
    • REGISTRY
    • INTERVENTION
    • DYSFUNCTION
    • GUIDELINE

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