[Impact of timing of intervention on prognosis of non-ST segment elevation acute coronary syndrome patients with renal dysfunction].

OBJECTIVE: To investigate the effects of intervention treatment in relation to renal function in patients with non-ST segment elevation acute coronary syndrome (NSTEACS). METHODS: A total of 815 NSTEACS patients were randomized to receive either early intervention (coronary angiography within 24 h of randomization) or delayed intervention (coronary angiography over 36 h after randomization). Serum creatinine was determined in 781 patients at admission and glomerular filtration rate (eGFR) calculated by the abbreviated MDRD formula. The subjects were stratified according to eGFR≥90 ml×min(-1)·(1.73 m2)(-1), 60≤eGFR<90 ml×min(-1)·(1.73 m2)(-1) and eGFR<60 ml×min(-1)·(1.73 m2)(-1) and followed up for 180 days. Death, myocardial infarction or stroke was regarded as the primary end point. RESULTS: Incidence of the primary end point was 6.3% at eGFR≥90 ml×min(-1)(1.73 m2)(-1), 10.1% at 60≤eGFR<90 ml×min(-1)·(1.73 m2)(-1) and 15.5% at eGFR<60 ml×min(-1)·(1.73 m2)(-1) (P=0.032). The 180 day mortality was 1.9% at eGFR≥90 ml×min(-1) (1.73 m2)(-1), 2.6% at 60≤eGFR<90 ml×min(-1)·(1.73 m2)(-1) and 9.1% at eGFR<60 ml×min(-1)·(1.73 m2)(-1) (P=0.01). In a logistic regression analysis, adjusting for other important covariables, the delayed intervention remained independently associated with the risk of primary end point in 60≤eGFR<90 ml×min(-1)·(1.73 m2)(-1) group (odds ratio, 2.106 ; 95% confidence interval, 1.102-4.024). CONCLUSION: The strategy of early intervention reduces the risk of death/MI or stroke at 180 days in NSTEACS patients with mild renal dysfunction.