Impact of Chronic Kidney Disease on Utilization of Coronary Angiography and Percutaneous Coronary Intervention, and Their Outcomes in Patients With Non-ST Elevation Myocardial Infarction

Value of the high-sensitivity troponin T assay for diagnosis of acute myocardial infarction in patients with and without renal insufficiency

“…In subgroup analyses, we divided patients into 5 groups according to eGFR (stage 1, eGFR !90 mL/min/ 1.73 m 2 ; stage 2, eGFR 60-89 mL/min/1.73 m 2 ; stage 3, eGFR 30-59 mL/min/1.73 m 2 ; stage 4, eGFR 15-29 mL/ min/1.73 m 2 ; stage 5 eGFR <15 mL/min/1.73 m 2 or under renal replacement therapy. ), and divided patients into young and old groups by age of 70, with and without underlying CAD, and with and without underlying heart failure (Table 6).…”

“…Ascertainment of the final diagnosis of AMI is a critical issue. Previous studies have adjudicated the final diagnosis based on clinical, laboratory, and imaging findings by cardiologists [2,29,31]. However, we defined AMI clearly and objectively according to image findings (coronary angiography or echocardiography combined with electrocardiography).…”

“…Chronic kidney disease (CKD) is an independent risk factor for AMI and the risk increases with advanced renal insufficiency [2,3]. Additionally, AMI patients comorbid with CKD are not ideal patients for coronary angiography and percutaneous coronary intervention, therefore having higher mortality rates than AMI patients without CKD [2,[4][5][6][7][8]. Furthermore, AMI patients comorbid with advanced CKD have a higher rate of long-term adverse cardiac events than those with normal kidney function [9].…”

“…Acute myocardial infarction (AMI) is a major cause of mortality and disability around the world [ 1 ]. Chronic kidney disease (CKD) is an independent risk factor for AMI and the risk increases with advanced renal insufficiency [ 2 , 3 ]. Additionally, AMI patients comorbid with CKD are not ideal patients for coronary angiography and percutaneous coronary intervention, therefore having higher mortality rates than AMI patients without CKD [ 2 , 4–8 ].…”

“…Furthermore, AMI patients comorbid with advanced CKD have a higher rate of long-term adverse cardiac events than those with normal kidney function [ 9 ]. Coronary revascularization in the case of an AMI is associated with lower in-hospital mortality and 12-month mortality versus conservative management in patients with CKD [ 2 , 4 , 8 , 10 ]. However, the key concern in performing coronary angiography in CKD patients is the risk of contrast-induced toxicity, subsequent renal deterioration, and adverse long-term outcomes [ 11 ].…”