Early Invasive Strategy and Outcome ofNon-ST-Segment Elevation MyocardialInfarction Patients WithChronicKidney Disease.

Abstract

Current guidelines suggest that an early invasive strategy should be considered for the treatment of non-ST-segment elevation myocardial infarction (NSTEMI). Although chronic kidney disease (CKD) is common among NSTEMI patients, these patients are under-represented in clinical trials, and data regarding their management are limited. The authors sought to evaluate the association between early invasive strategy and long-term survival among patients with NSTEMI and CKD. This was a retrospective analysis of 7,107 consecutive NSTEMI patients between 2008 and 2021. Patients were dichotomized into early (≤24 hours) and delayed invasive groups and stratified by kidney function. Inverse probability treatment weighting was used to adjust for differences in baseline characteristics. The primary outcome wasall-cause mortality. The final study population comprised 3,529 invasively treated patients with a median age of 66 years (IQR:58-74 years), 1,837 (52%) of whom were treated early. There were 483 (14%) patients with at least moderate CKD(estimated glomerular filtration rate [eGFR]<45mL/min/1.73m2). During a median follow-up of 4 years (IQR: 2-6years), 527 (15%) patients died. After inverse probability treatment weighting, an early invasive strategy was associated with a significant 30% lower mortality compared with a delayed strategy (HR: 0.7; 95%CI: 0.56-0.85). The association between early invasive strategy and mortality was modified by eGFR (Pinteraction< 0.001) and declined with lower renal function, with no difference in mortality among patients with eGFR<45 mL/min/1.73m2 (HR: 0.89; 95%CI: 0.64-1.24). Among NSTEMI patients, the association of early invasive strategy with long-term survival is modified by CKD and was not observed in patients with eGFR<45mL/min/1.73m2.