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Invasive Strategies Tied to Lower NSTEMI Mortality in CKD

But conservative approach beneficial for those with severe CKD with non-ST-segment elevation MI

TUESDAY, July 5 (HealthDay News) -- The management of non-ST-segment elevation myocardial infarction (NSTEMI) with invasive strategies (early invasive [EI] and deferred invasive [DI]) in patients with chronic kidney disease (CKD) is associated with significantly decreased mortality compared to a conservative strategy, except for patients with severe CKD, according to a study published in the July 15 issue of The American Journal of Cardiology.

Daisuke Hachinohe, M.D., from the Chonnam National University Hospital in Gwangju, Republic of Korea, and colleagues compared the clinical outcomes among EI, DI, and conservative strategies in 5,185 patients with acute NSTEMI and CKD. Patients were divided into groups depending on the treatment modality used and classified into four stages according to the National Kidney Foundation's staging of kidney disease. During a one-year follow-up, the EI and DI groups were compared with the conservative groups and according to each renal function stage.

The investigators found that, with the exception of patients in the severe CKD group, patients in the conservative treatment group had a significantly higher mortality rate than those in the invasive group. Although there were no significant differences between the EI and DI groups, decreased renal function was associated with decreased benefits of the EI strategy over the DI strategy.

"In the management of NSTEMI, an invasive strategy decreased mortality compared to a conservative strategy except for severe CKD. In the timing of an invasive strategy, the EI strategy was observed to be superior to the DI strategy in patients with mild CKD; however, this tendency reversed as renal function decreased," the authors write.

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