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Guidelines needed to improve care for patients with MI, chronic kidney disease

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Patients presenting with STEMI and non-STEMI who have chronic kidney disease were less likely to receive evidence-based therapies and had higher mortality rates than those without chronic kidney disease, data from a recent study suggested.

The researchers evaluated and characterized short-term outcomes related to kidney disease in a study sample that included 19,029 patients with STEMI and 30,462 patients with non-STEMI drawn from the Acute Coronary Treatment and Intervention Outcomes Network registry.

According to the results, 30.5% of patients with STEMI and 42.9% of patients with non-STEMI had chronic kidney disease, and the overall risk of mortality increased with the stage of chronic kidney disease. Among patients presenting with STEMI, 2.3% of patients without chronic kidney disease died, compared with 8.8% of patients with stage IIIa, 17.9% with stage IIIb, 27.3% with stage IV and 31.8% with stage V chronic kidney disease (P<.0001 for interaction). Death ORs in patients with STEMI who had chronic kidney disease relative to those without chronic kidney disease were 2.5 for stage IIIa, 3.7 for stage IIIb, 4.8 for stage IV and 8.0 for stage V (P<.0001 for trend).

ORs for patients with non-STEMI were 1.8 for stage IIIa, 2.4 for stage IIIb, 3.5 for stage IV and 4.1 for stage V chronic kidney disease (P<.0001 for trend). In patients with STEMI, the OR for any reperfusion therapy was lower with worsening chronic kidney disease stage (P=.0005 for trend), but the use of percutaneous coronary intervention and thrombolytics were similar. Among patients with non-STEMI, those with chronic kidney disease were less likely to undergo early invasive therapy (P<.0001 for trend) or any revascularization (P<.0001 for trend).

“Reports over the past decade have highlighted the importance of chronic kidney disease among patients with MI,” the researchers wrote. “Data from this contemporary cohort suggest that patients with chronic kidney disease still receive fewer evidence-based therapies and have substantially higher mortality rates. Additional research to define optimal post-MI care in patients with chronic kidney disease is warranted.”

Fox C. Circulation. 2010;121:357-365.