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PERCUTANEOUS CORONARY INTERVENTION IS ASSOCIATED WITH DECREASED MORTALITY IN NSTEMI PATIENTS WITH ADVANCED CKD
1283 JACC March 21, 2017 Volume 69, Issue 11
Interventional Cardiology PERCUTANEOUS CORONARY INTERVENTION IS ASSOCIATED WITH DECREASED MORTALITY IN NSTEMI PATIENTS WITH ADVANCED CKD Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m. Session Title: Timely Topics in Acute Coronary Syndromes Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology Presentation Number: 1242-166 Authors: Subir Bhatia, Shilpkumar Arora, Sravya Mallam, Kanishk Agnihotri, Parshva Patel, Nilay Patel, Apurva Badheka, Sidakpal Panaich, Abhishek Deshmukh, Mayo Clinic, Rochester, MN, USA
Background: Chronic kidney disease (CKD) remains a significant independent predictor of cardiovascular morbidity and mortality. However, there is an insufficient amount of revascularization data in non-ST-segment elevation myocardial infarction (NSTEMI) patients with CKD, especially at advanced stages (stages 4 and 5), as underscored by the 2014 AHA/ACC Guidelines. The purpose of this study is to better characterize the utilization of primary cutaneous intervention (PCI) in NSTEMI patients with CKD.
Methods: Using the 2004-2013 National Inpatient Sample, the largest publicly available inpatient care database representing more than 95% of the US population, we extracted data using the ICD 9 code 410.7 (NSTEMI) as the primary diagnosis and the ICD 9 code 585 (CKD) as the secondary diagnosis. We excluded patients with missing information on age, sex, and mortality for a final sample size of 3,784,774. We used multilevel logistic and linear regression models with random effect to adjust for confounding. Our primary outcome was in-hospital mortality. Results: Among 3,784,774 admissions for NSTEMI, patients with CKD stage 1 or less, 2, 3, 4, and 5 constituted 88%, 0.6%, 4.4%, 1.9%, and 5.1% of admissions, respectively. Increasing CKD severity was associated with advancing age, length of stay, and presence of diabetes mellitus, heart failure, peripheral vascular disease, anemia, and weight loss.
The use of PCI was associated with a 65%, 59%, 44%, and 52% reduction in in-hospital mortality in NSTEMI patients with CKD stage 2 or less, 3, 4, and 5, respectively (p<.0001). NSTEMI patients with CKD stage 2, 3, 4, and 5 had a 25%, 31%, 60%, and 46% less likelihood to undergo PCI compared to NSTEMI patients with CKD stage 1 or less (p<.0001). NSTEMI patients with any degree of CKD were 22% less likely to undergo PCI if they were female. Conclusions: In NSTEMI patients, increasing severity of CKD was associated with increased rates of myocardial infarction and in-hospital death. Despite this, increasing severity of CKD was associated with a significant underutilization of PCI. The use of PCI in NSTEMI was associated with a significantly decreased rate of in-hospital mortality in all CKD stages.
Interventional Cardiology PERCUTANEOUS CORONARY INTERVENTION IS ASSOCIATED WITH DECREASED MORTALITY IN NSTEMI PATIENTS WITH ADVANCED CKD Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m. Session Title: Timely Topics in Acute Coronary Syndromes Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology Presentation Number: 1242-166 Authors: Subir Bhatia, Shilpkumar Arora, Sravya Mallam, Kanishk Agnihotri, Parshva Patel, Nilay Patel, Apurva Badheka, Sidakpal Panaich, Abhishek Deshmukh, Mayo Clinic, Rochester, MN, USA
Background: Chronic kidney disease (CKD) remains a significant independent predictor of cardiovascular morbidity and mortality. However, there is an insufficient amount of revascularization data in non-ST-segment elevation myocardial infarction (NSTEMI) patients with CKD, especially at advanced stages (stages 4 and 5), as underscored by the 2014 AHA/ACC Guidelines. The purpose of this study is to better characterize the utilization of primary cutaneous intervention (PCI) in NSTEMI patients with CKD.
Methods: Using the 2004-2013 National Inpatient Sample, the largest publicly available inpatient care database representing more than 95% of the US population, we extracted data using the ICD 9 code 410.7 (NSTEMI) as the primary diagnosis and the ICD 9 code 585 (CKD) as the secondary diagnosis. We excluded patients with missing information on age, sex, and mortality for a final sample size of 3,784,774. We used multilevel logistic and linear regression models with random effect to adjust for confounding. Our primary outcome was in-hospital mortality. Results: Among 3,784,774 admissions for NSTEMI, patients with CKD stage 1 or less, 2, 3, 4, and 5 constituted 88%, 0.6%, 4.4%, 1.9%, and 5.1% of admissions, respectively. Increasing CKD severity was associated with advancing age, length of stay, and presence of diabetes mellitus, heart failure, peripheral vascular disease, anemia, and weight loss.
The use of PCI was associated with a 65%, 59%, 44%, and 52% reduction in in-hospital mortality in NSTEMI patients with CKD stage 2 or less, 3, 4, and 5, respectively (p<.0001). NSTEMI patients with CKD stage 2, 3, 4, and 5 had a 25%, 31%, 60%, and 46% less likelihood to undergo PCI compared to NSTEMI patients with CKD stage 1 or less (p<.0001). NSTEMI patients with any degree of CKD were 22% less likely to undergo PCI if they were female. Conclusions: In NSTEMI patients, increasing severity of CKD was associated with increased rates of myocardial infarction and in-hospital death. Despite this, increasing severity of CKD was associated with a significant underutilization of PCI. The use of PCI in NSTEMI was associated with a significantly decreased rate of in-hospital mortality in all CKD stages.