PURPOSE: Patients with coronary artery disease (CAD) and renal insufficiency (RI) have higher rates of morbidity and mortality than patients with CAD and no RI. However, whether early invasive treatment in NSTEMI, defined as Troponin I elevation of more than 0.2 mg/dl with or without EKG changes without ST elevation, carries a different prognosis in patients with RI is not known.
METHODS: We analyzed data in 685 consecutive patients who were admitted with NSTEMI over a period of two years, 71 of whom had RI defined as a creatinine >=1.5) and not on dialysis and underwent cardiac catheterization. We reviewed time to catheterization (intervention) as <12 hours (hrs), 12 to 24 hrs, 24-48 hrs and co-morbid illnesses and outcome in patients with and without RI. Primary outcomes included mortality, congestive heart failure (CHF) and myocardial infarction (MI). Secondary outcomes included RBC transfusion rates and the use of IIbIIIa inhibitors.
RESULTS: As expected, there was a significantly higher (p< 0.01) incidence of hypertension, peripheral vascular disease, prior history of MI, coronary bypass surgery and CHF in the 71 patients with NSTEMI and RI than the 614 patients who do not have a history of RI. There was a higher rate of intervention in patients without RI than in those with RI (90.5% vs 76.1%; p< 0.001). The incidence of mortality (14.1% vs. 2.8%; p< 0.001), cardiogenic shock (14.1 % vs. 1.6 %; p< 0.001), CHF (9.9% vs. 3.3%; p< 0.02), RBC transfusion (26.8% vs. 14.2%; p< 0.005) were all higher in patients with RI than without RI.
CONCLUSION: NSTEMI patients with RI have a higher mortality and morbidity in the form of CHF, cardiogenic shock, need for RBC transfusion.
CLINICAL IMPLICATIONS: Patients with RI should be more aggressively treated but expect poor outcomes.
DISCLOSURE: Dr. Dinesh Pubbi, None.