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

401



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