Baylor University Medical Center Proceedings October 2017 - 401
Table 1. NSTE-ACS group patient characteristics
Variable
Table 2. STEMI group patient characteristics
No CKD CKD stages ESRD
(n =
III-V
(n =
513,185) (n = 41,999) 24,563) P value
No CKD CKD stages
III-V
(n =
281,106) (n = 8123)
Variable
Age >65 years
54.5%
80.0%
56.3%
<0.001
Age >65 years
42.2%
Caucasian
63.3%
64.5%
43.2%
<0.001
Caucasian
ESRD
(n =
4721)
P value
77%
57.2% <0.001
63.9%
65%
45.9% <0.001
33.6%
41.7%
43.9% <0.001
3.2%
1.2%
1.0% <0.001
Female gender
43.4%
43.1%
44.1%
0.004
Female gender
Alcohol abuse
3.0%
1.3%
1.0%
<0.001
Alcohol abuse
21.7%
26.6%
21.7%
<0.001
Chronic pulmonary disease
15.5%
21.6%
17.2% <0.001
25.6%
47.1%
56.6% <0.001
58.2%
81.1%
85.2% <0.001
0.7%
1%
0.5% <0.001
10.4%
12.7%
8.8% <0.001
7%
17.8%
21.2% <0.001
Small
10.2%
11.2%
9.2% <0.001
Medium
22.6%
22.8%
22.3%
Large
67.2%
66%
68.4%
Rural
10.8%
11.4%
Urban nonteaching
42.8%
43.2%
Chronic pulmonary disease
Diabetes mellitus
33.1%
54.1%
62.5%
<0.001
Diabetes mellitus
Hypertension
67.5%
82.0%
87.4%
<0.001
Hypertension
Metastatic cancer
Metastatic cancer
0.9%
0.9%
0.6%
<0.001
Obesity
12.3%
14.1%
10.0%
<0.001
Peripheral vascular disease
10.1%
21.7%
23.2%
<0.001
Peripheral vascular disease
Bed size of hospital
Bed size of hospital
Small
11.0%
10.5%
7.9%
Medium
24.4%
23.8%
23.0%
Large
64.6%
65.8%
69.1%
<0.001
Rural
12.0%
10.4%
7.1%
Urban nonteaching
42.5%
42.9%
41.2%
Urban teaching
45.4%
46.6%
51.7%
Weekend admission
25.1%
26.3%
23.1%
<0.001
Elective admission
7.2%
5.5%
6.2%
<0.001
Teaching status of hospital
Teaching status of hospital
<0.001
CKD indicates chronic kidney disease; ESRD, end-stage renal disease; NSTE-ACS, non-ST
elevation acute coronary syndrome.
patients without CKD had CAG, slightly more than half of
them received PCI. Higher all-cause hospital mortality was
noted among those with an advanced degree of renal dysfunction, with the mortality risk being higher in STEMI than in
NSTE patients.
About one-fourth of STEMI patients with ESRD died during hospitalization. The prevalence of in-hospital mortality was
nearly double in the STEMI patients than in the NSTE-ACS
patients. After adjusting for key variables, performance of PCI
in NSTE-ACS was associated with a lower risk of hospital mortality across all degrees of CKD, with adjusted odds ratios of
0.44 for no CKD, 0.48 for CKD III-V, and 0.46 for ESRD.
Similarly, PCI in STEMI independently predicted lower inhospital mortality across the CKD spectrum, with adjusted
odds ratios of 0.35 for no CKD, 0.50 for CKD III-V, and 0.52
for ESRD (Table 3).
DISCUSSION
Our study showed that an increasing number of patients
undergo CAG and PCI for any renal stages, and PCI was
associated with marked reduction in mortality risk. Importantly, among patients presenting with STEMI, more underwent CAG and PCI from 2006 to 2012, though there was
October 2017
Obesity
9.1% <0.001
43.8%
Urban teaching
46.4%
45.4%
47.1%
Weekend admission
27.5%
26.5%
25.4% <0.001
Elective admission
7.1%
6.3%
7.1%
0.007
CKD indicates chronic kidney disease; ESRD, end-stage renal disease; STEMI,
ST-elevation myocardial infarction.
a disparity between patients with or without CKD. CKD is
a known risk factor for increased AMI-related mortality (1).
Charytan and colleagues previously reported underperformance of PCI in CKD patients, but the data represented only
Table 3. Adjusted odd ratios for in-hospital mortality for patients
undergoing percutaneous coronary intervention
Presentation
Baseline renal function
NSTE-ACS
No CKD
0.44 (0.42-0.47)
<0.001
CKD III-V
0.48 (0.42-0.56)
<0.001
ESRD
0.46 (0.40-0.53)
<0.001
No CKD
0.35 (0.34-0.36)
<0.001
CKD III-V
0.50 (0.43-0.58)
<0.001
ESRD
0.52 (0.45-0.61)
<0.001
STEMI
Odd ratio (95% CI) P value
CI indicates confidence interval; CKD, chronic kidney disease; ESRD, end-stage renal
disease; NSTE-ACS, non-ST elevation acute coronary syndrome; STEMI, ST-elevation
myocardial infarction. The model is adjusted for age, gender, race, Charlson comorbidity
index, weekend and elective admissions, insurance type, alcohol abuse, anemia, arthritic
conditions, chronic lung disease, coagulopathy, depression, diabetes, drug abuse, hypertension, hypothyroidism, liver disease, fluids and electrolyte disorders, obesity, peripheral
vascular disease, pulmonary circulatory disorders, year of admission, bed size and
teaching status/location of hospitals, acute kidney injury, lymphoma, metastatic cancer,
psychosis, solid tumor without metastases, and percutaneous coronary interventions.
Percutaneous coronary intervention and inpatient mortality
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