RESUMO
BACKGROUND AND AIM: Patients with chronic kidney disease (CKD) have an increased risk of adverse cardiovascular outcomes after non-ST elevation acute coronary syndrome (NSTEACS). However, the information available on this specific population, is scarce. We evaluate the impact of CKD on long-term prognosis in patients with NSTEACS managed with invasive strategy. METHODS: We conduct a prospective registry of patients with NSTEACS and coronary angiography. CKD was defined as a glomerular filtration rate < 60ml/min/1,73m2. 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 p 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<.0001) with more prevalence of hypertension (89.6 vs. 66.3%; P<.0001), diabetes (53.7 vs. 35.9%; P=.011), history of heart failure (13.4 vs. 3.9%; P=.006) and anemia (47.8 vs. 16%; P<.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=.001) and HR of the primary combined end-point (HR: 1.94; CI95%: 1.12-3.27; P=.012). CKD was an independent predictor of adverse cardiovascular outcomes at 3-years (HR: 1.66; CI95%: 1.05-2.61; P=.03). CONCLUSIONS: In NSTEACS patients treated with invasive strategie CKD is associated independently with an increased risk of adverse cardiovascular outcomes at 3years.
Assuntos
Síndrome Coronariana Aguda/etiologia , Síndrome Coronariana Aguda/cirurgia , Infarto do Miocárdio sem Supradesnível do Segmento ST/etiologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/cirurgia , Insuficiência Renal Crônica/complicações , Síndrome Coronariana Aguda/epidemiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/epidemiologia , Prognóstico , Estudos Prospectivos , Fatores de TempoRESUMO
Introducción y objetivo: Los pacientes con enfermedad renal crónica (ERC) presentan mayor riesgo de eventos adversos cardiovasculares tras un síndrome coronario agudo sin elevación del segmento ST (SCASEST). Sin embargo, la información disponible en esta población específica es escasa. Evaluamos el efecto de la ERC en el pronóstico a largo plazo de pacientes con SCASEST tratados con estrategia invasiva. Métodos: Registro prospectivo de pacientes con SCASEST y coronariografía. Definimos ERC como una tasa de filtrado glomerular < 60ml/min/1,73m2. La variable de valoración final fue el combinado de muerte y reingreso cardiovasculares (nuevo síndrome coronario agudo, insuficiencia cardíaca e ictus no fatales). Estimamos la probabilidad acumulada, estratificada por ERC, y la relación entre esta y la tasa de riesgo del evento combinado a 3 años. Resultados: Incluimos a 248 pacientes, con media de edad de 66,9 años; el 25% eran mujeres. Los 67 casos (27%) con ERC fueron mayores (74,9 vs. 63,9 años; p < 0,0001) y con más prevalencia de hipertensión (89,6 vs. 66,3%; p < 0,0001), diabetes (53,7 vs. 35,9%; p = 0,01), historia de insuficiencia cardíaca (13,4 vs. 3,9%; p = 0,006) y anemia (47,8 vs. 16%; p < 0,0001). Sin diferencias en la extensión de la enfermedad coronaria. La ERC se asoció a mayor probabilidad (49,3 vs. 28,2%; log-rank p = 0,001) y tasa de riesgo del evento combinado (HR ajustada: 1,94; IC 95%: 1,12-3,27; p = 0,012). La ERC fue predictor independiente de eventos (HR: 1,66; IC 95%: 1,05-2,61; p = 0,03). Conclusiones: En pacientes con SCASEST tratados con estrategia invasiva, la ERC se asocia de manera independiente a mayor riesgo de eventos cardiovasculares a 3 años (AU)
Background and aim: Patients with chronic kidney disease (CKD) have an increased risk of adverse cardiovascular outcomes after non-ST elevation acute coronary syndrome (NSTEACS). However, the information available on this specific population, is scarce. We evaluate the impact of CKD on long-term prognosis in patients with NSTEACS managed with invasive strategy. Methods: We conduct a prospective registry of patients with NSTEACS and coronary angiography. CKD was defined as a glomerular filtration rate < 60ml/min/1,73m2. 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 p 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<.0001) with more prevalence of hypertension (89.6 vs. 66.3%; P<.0001), diabetes (53.7 vs. 35.9%; P=.011), history of heart failure (13.4 vs. 3.9%; P=.006) and anemia (47.8 vs. 16%; P<.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=.001) and HR of the primary combined end-point (HR: 1.94; CI95%: 1.12-3.27; P=.012). CKD was an independent predictor of adverse cardiovascular outcomes at 3-years (HR: 1.66; CI95%: 1.05-2.61; P=.03). Conclusions: In NSTEACS patients treated with invasive strategie CKD is associated independently with an increased risk of adverse cardiovascular outcomes at 3years (AU)
