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Varian FL, Parker WAE, Fotheringham J, Storey RF. Treatment inequity in antiplatelet therapy for ischaemic heart disease in patients with advanced chronic kidney disease: releasing the evidence vacuum. Platelets 2023; 34:2154330. [DOI: 10.1080/09537104.2022.2154330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Frances L. Varian
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK and
| | - William A. E. Parker
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK and
| | - James Fotheringham
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Robert F. Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK and
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Sugiharto F, Trisyani Y, Nuraeni A, Mirwanti R, Melati Putri A, Aghnia Armansyah N. Factors Associated with Increased Length of Stay in Post Primary Percutaneous Coronary Intervention Patients: A Scoping Review. Vasc Health Risk Manag 2023; 19:329-340. [PMID: 37304338 PMCID: PMC10253007 DOI: 10.2147/vhrm.s413899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023] Open
Abstract
Several studies identify factors affecting increased length of stay (LOS) in patients with post-primary percutaneous coronary intervention (PCI). However, there has not been a review study that synthesizes these results. This study aimed to describe the duration of LOS and factors associated with increased LOS among patients with STEMI after PPCI. This study used scoping review using EBSCO-host Academic Search Complete, PubMed, Scopus, Taylor & Francis, and Google Scholar databases. The keywords used in English were "adults OR middle-aged" AND "length of stay OR hospital stay" AND "primary percutaneous coronary intervention OR PPCI" AND "myocardial infarction OR coronary infarction OR cardiovascular disease". The inclusion criteria for articles were: the article was a full-text in English; the sample was STEMI patients who had undergone a PPCI procedure; and the article discussed the LOS. We found 13 articles discussing the duration and factors affecting LOS in patients post-PPCI. The duration of LOS was the fastest 48 hours, and the longest of LOS was 10.2 days. Factors influencing LOS are categorized into three predictors: low, moderate, and high. Post-procedure complications after PPCI was the most influential factors in increasing the LOS duration. Professional health workers, especially nurses, can identify various factors that can be modified to prevent complications and worsen disease prognosis to increase LOS efficiency.
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Affiliation(s)
- Firman Sugiharto
- Faculty of Nursing, Universitas Padjadjaran, Sumedang, Jawa Barat, Indonesia
| | - Yanny Trisyani
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Jawa Barat, Indonesia
| | - Aan Nuraeni
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Jawa Barat, Indonesia
| | - Ristina Mirwanti
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Jawa Barat, Indonesia
| | - Azalia Melati Putri
- Faculty of Nursing, Universitas Padjadjaran, Sumedang, Jawa Barat, Indonesia
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3
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Lao Y, Chen K, Feng L, Yuan Y, Zhang J, Zhang L, Huang X, Li M, Wu Z, Bin J, Liao Y. Delayed PCI is not beneficial for STEMI patients with impaired renal function: a retrospective cohort study. BMC Cardiovasc Disord 2023; 23:263. [PMID: 37208590 DOI: 10.1186/s12872-023-03271-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 04/28/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Preexisting impaired renal function (IRF) and contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) are important prognostic parameters, but it is unknown whether delayed PCI is still beneficial for STEMI patients with IRF. METHODS A retrospective single-center cohort study was performed in 164 patients who presented at least 12 h after symptom onset, and were diagnosed with STEMI and IRF. They were assigned to two groups to receive PCI plus optimal medical therapy (OMT) and OMT alone respectively. Clinical outcomes at 30 days and 1 year were compared between two groups, and hazard ratio for survival was analyzed using Cox regression model. A power analysis demanded 34 patients in each group to produce a power of 90% and a P value of 0.05. RESULTS The 30-day mortality was significantly lower in PCI group (n = 126) than in non-PCI group (n = 38) (11.1% versus 28.9%, P = 0.018), while there was no significant difference in the 1-year mortality and incidence of cardiovascular comorbidities between the two groups. Cox regression analysis showed that patients with IRF didn't benefit from receiving PCI on survival rate (P = 0.267). CONCLUSIONS Delayed PCI is not beneficial on one-year clinical outcomes for STEMI patients with IRF.
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Affiliation(s)
- Yi Lao
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Heart Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong province, China
| | - Kaitong Chen
- Cardiovascular Department, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong Province, China.
| | - Li Feng
- Department of Cardiology, Zhongshan Hospital, Sun Yat-sen University, Zhongshan City, Guangdong province, China
| | - Yong Yuan
- Department of Cardiology, Zhongshan Hospital, Sun Yat-sen University, Zhongshan City, Guangdong province, China
| | - Jin Zhang
- Department of Cardiology, Zhongshan Hospital, Sun Yat-sen University, Zhongshan City, Guangdong province, China
| | - Liting Zhang
- Department of Cardiology, Zhongshan Hospital, Sun Yat-sen University, Zhongshan City, Guangdong province, China
| | - Xuansheng Huang
- Department of Cardiology, Zhongshan Hospital, Sun Yat-sen University, Zhongshan City, Guangdong province, China
| | - Mingxing Li
- Department of Cardiology, Zhongshan Hospital, Sun Yat-sen University, Zhongshan City, Guangdong province, China
| | - Zidi Wu
- Department of Cardiology, Zhongshan Hospital, Sun Yat-sen University, Zhongshan City, Guangdong province, China
| | - Jianping Bin
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Heart Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong province, China
| | - Yulin Liao
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Heart Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong province, China.
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Engelbertz C, Feld J, Makowski L, Kühnemund L, Fischer AJ, Lange SA, Günster C, Dröge P, Ruhnke T, Gerß J, Freisinger E, Reinecke H, Köppe J. Contemporary in-hospital and long-term prognosis of patients with acute ST-elevation myocardial infarction depending on renal function: a retrospective analysis. BMC Cardiovasc Disord 2023; 23:62. [PMID: 36732721 PMCID: PMC9896822 DOI: 10.1186/s12872-023-03084-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/19/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Cardiovascular disease is often associated with chronic kidney disease (CKD), resulting in an increased risk for poor outcome. We sought to determine short-term mortality and overall survival in ST-elevation myocardial infarction (STEMI) patients with different stages of CKD. METHODS In our retrospective cohort study with health insurance claims data of the Allgemeine Ortskrankenkasse (AOK), anonymized data of all STEMI patients hospitalized between 2010 and 2017 were analyzed regarding presence and severity of concomitant CKD. RESULTS A total of 175,187 patients had an index-hospitalisation for STEMI (without CKD: 78.6% patients, CKD stage 1: 0.8%, CKD stage 2: 4.8%, CKD stage 3: 11.7%, CKD stage 4: 2.8%, CKD stage 5: 0.7%, CKD stage 5d: 0.6%). Patients with CKD were older and had more co-morbidities than patients without CKD. With increasing CKD severity, patients received less revascularization therapies (91.2%, 85.9%, 87.0%, 81.8%, 71.7%, 76.9% and 78.6% respectively, p < 0.001). After 1 year, guideline-recommended medications were prescribed less frequently in advanced CKD (83.4%, 79.3%, 81.5%, 74.7%, 65.0%, 59.4% and 53.7%, respectively, p < 0.001). CKD stages 4, 5 and 5d as well as chronic limb threatening ischemia (CLTI) were associated with decreased overall survival [CKD stage 4: hazard ratio (HR) 1.72; 95% CI 1.66-1.78; CKD stage 5: HR 2.55; 95% CI 2.37-2.73; CKD stage 5d: 5.64; 95% CI 5.42-5.86; CLTI: 2.06; 95% CI 1.98-2.13; all p < 0.001]. CONCLUSIONS CKD is a frequent co-morbidity in patients with STEMI and is associated with a worse prognosis especially in advanced stages. Guideline-recommended therapies in patients with STEMI and CKD are still underused.
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Affiliation(s)
- Christiane Engelbertz
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany.
| | - Jannik Feld
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Lena Makowski
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | - Leonie Kühnemund
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | - Alicia Jeanette Fischer
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Cardiol, Muenster, Germany
| | - Stefan A Lange
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | | | | | | | - Joachim Gerß
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Eva Freisinger
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | - Holger Reinecke
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | - Jeanette Köppe
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
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Hussein U, Cimini M, Handelman GJ, Raimann JG, Liu L, Abbas SR, Kotanko P, Levin NW, Finkelstein FO, Zhu F. Identification of fluid overload in elderly CKD Patients using bioimpedance techniques. J Appl Physiol (1985) 2022; 133:205-213. [PMID: 35652832 DOI: 10.1152/japplphysiol.00645.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Diagnosis of fluid overload (FO) in early stage is essential to manage chronic kidney disease (CKD) patients' fluid balance and to prevent cardiovascular disease (CVD). However, identification of fluid status in CKD patient is largely dependent on physician's clinical acumen. The ratio of fluid overload to extracellular volume (FO/ECV) has been used as a reference to assess fluid status. The primary aim of this study was to compare FO/ECV with other bioimpedance methods and clinical assessment in CKD patients. Whole body ECV, intracellular volume (ICV), total body water (TBW) and calf normalized resistivity (CNR) were measured (Hydra 4200). Thresholds of FO utilizing CNR and ECV/TBW were derived by receiver operator characteristic (ROC) analysis based on data from pooled CKD patients and healthy subjects (HS). Clinical assessments of FO in CKD patients were performed by nephrologists . CKD (stage 3 and stage 4) patients (n=50) and HS (n=189) were studied. The thresholds of FO were ≤ 14.3 (10-2 Ωm3/kg) for females and ≤ 13.1 (10-2 Ωm3/kg) for males using CNR and ≥ 0.445 in females and ≥ 0.434 in males using ECV/TBW. FO was diagnosed in 78%, 62% and 52% of CKD patients by CNR, FO/ECV and ECV/TBW, respectively while only 24% of CKD patients were diagnosed to be FO by clinical assessment . The proportion of FO in non-dialysis CKD patients was largely underestimated by clinical assessment compared to FO/ECV, CNR and ECV/TBW. CNR, and FO/ECV methods were more sensitive than ECV/TBW in identifying fluid overload in these CKD patients.
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Affiliation(s)
- Usama Hussein
- Renal Research Institute, New Haven, New Haven, CT, United States
| | - Monica Cimini
- Renal Research Institute, New Haven, New Haven, CT, United States
| | - Garry J Handelman
- Renal Research Institute, New York, NY, United States.,University of Massachusetts, Lowell, MA, United States
| | | | - Li Liu
- Renal Research Institute, New York, NY, United States.,Renal Division, Peking University First Hospital, Beijing, China
| | - Samer R Abbas
- Renal Research Institute, New York, NY, United States
| | - Peter Kotanko
- Renal Research Institute, New York, NY, United States.,Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nathan W Levin
- Renal Research Institute, New York, NY, United States.,Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Fredric O Finkelstein
- Renal Research Institute, New Haven, New Haven, CT, United States.,Yale University, New Haven, CT, United States
| | - Fansan Zhu
- Renal Research Institute, New York, NY, United States
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Rey PT, García OO, Cid Álvarez AB, Juskova M, Álvarez BÁ, García Acuña JM, Bermejo RA, Veloso PR, Otero DL, Sanmartín Pena JC, Nouche RT, González-juanatey JR. Prognostic impact of renal function trajectories in patients with STEMI and kidney dysfunction undergoing primary percutaneous coronary intervention: analysis of ten years all comers registry. Hellenic J Cardiol 2022. [DOI: 10.1016/j.hjc.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 04/13/2022] [Accepted: 04/27/2022] [Indexed: 11/24/2022] Open
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Schmucker J, Fach A, Osteresch R, Mata Marin LA, Retzlaff T, Rühle S, Garstka D, Kuhlmann U, Eitel I, Hambrecht R, Wienbergen H. Temporal trends in treatment strategies and clinical outcomes among patients with advanced chronic kidney disease and ST-elevation myocardial infarctions: results from the Bremen STEMI registry. BMC Cardiovasc Disord 2022; 22:142. [PMID: 35365074 PMCID: PMC8976374 DOI: 10.1186/s12872-022-02573-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although the detrimental effects of advanced chronic kidney disease (CKD) on prognosis in coronary artery disease is known, there are few data on the efficacy and safety of modern interventional therapies and medications in patients with advanced CKD, because this special patient cohort is often excluded or underrepresented in randomized trials. Methods In the present study all patients admitted with ST-elevation myocardial infarctions (STEMI) from the region of Bremen/Germany treated between 2006 and 2019 were analyzed. Advanced CKD was defined as glomerular filtration rate < 45 ml/min.
Results Of 9605 STEMI-patients, 1018 (10.6%) had advanced CKD with a serum creatinine of 2.22 ± 4.2 mg/dl at admission and with lower rates of primary percutaneous coronary intervention (pPCI) (84.1 vs. 94.1%, p < 0.01) and higher all-cause-mortality (44.4 vs. 3.6%, p < 0.01). Over time, advanced CKD-patients were more likely to be treated with pPCI (2015–2019: 90.3% vs. 2006–2010:75.8%, p < 0.01) and with ticagrelor/prasugrel (59.6% vs. 1.7%, p < 0.01) and drug eluting stents (90.7% vs. 1.3%, p < 0.01). During the study period a decline in adverse ischemic events (OR 0.3, 95% CI 0.1–0.7) and an increase in bleedings (OR 2.2, 95% CI 1.3–3.8) within 1 year after the index event could be observed in patients with advanced CKD while 1-year-mortality (OR 1.0, 95% CI 0.7–1.4) and rates of acute kidney injury (OR 1.2, 95% CI 0.8–1.7) did not change in a multivariate model. Both, ticagrelor/prasugrel (OR 0.48, 95% CI 0.2–0.98) and DES (OR 0.38, 95% CI 0.2–0.8) were associated with a decrease in ischemic events at 1 year. Conclusions During the observed time period STEMI-patients with advanced CKD were more likely to be treated with primary PCI, ticagrelor or prasugrel and DE-stents. These changes probably have contributed to the decline in ischemic events and the increase in bleedings within 1 year after STEMI while overall mortality at 1-year remained unchanged for this high-risk patient group.
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Affiliation(s)
- Johannes Schmucker
- From the Bremen Institute for Heart and Circulation Research, am Klinikum Links der Weser, Senator-Weßling-Str. 1, 28277, Bremen, Germany. .,Medical Clinic III, Department of Nephrology and Cardiology, Klinikum Bremen Mitte, Bremen, Germany.
| | - Andreas Fach
- From the Bremen Institute for Heart and Circulation Research, am Klinikum Links der Weser, Senator-Weßling-Str. 1, 28277, Bremen, Germany
| | - Rico Osteresch
- From the Bremen Institute for Heart and Circulation Research, am Klinikum Links der Weser, Senator-Weßling-Str. 1, 28277, Bremen, Germany
| | - Luis Alberto Mata Marin
- From the Bremen Institute for Heart and Circulation Research, am Klinikum Links der Weser, Senator-Weßling-Str. 1, 28277, Bremen, Germany
| | - Tina Retzlaff
- From the Bremen Institute for Heart and Circulation Research, am Klinikum Links der Weser, Senator-Weßling-Str. 1, 28277, Bremen, Germany
| | - Stephan Rühle
- From the Bremen Institute for Heart and Circulation Research, am Klinikum Links der Weser, Senator-Weßling-Str. 1, 28277, Bremen, Germany
| | - Daniela Garstka
- From the Bremen Institute for Heart and Circulation Research, am Klinikum Links der Weser, Senator-Weßling-Str. 1, 28277, Bremen, Germany
| | - Uwe Kuhlmann
- Medical Clinic III, Department of Nephrology and Cardiology, Klinikum Bremen Mitte, Bremen, Germany
| | - Ingo Eitel
- Medical Clinic II, University Heart Center, Lübeck, Germany
| | - Rainer Hambrecht
- From the Bremen Institute for Heart and Circulation Research, am Klinikum Links der Weser, Senator-Weßling-Str. 1, 28277, Bremen, Germany
| | - Harm Wienbergen
- From the Bremen Institute for Heart and Circulation Research, am Klinikum Links der Weser, Senator-Weßling-Str. 1, 28277, Bremen, Germany.,Medical Clinic II, University Heart Center, Lübeck, Germany
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Kuźma Ł, Małyszko J, Kurasz A, Niwińska MM, Zalewska-Adamiec M, Bachórzewska-Gajewska H, Dobrzycki S. Impact of renal function on patients with acute coronary syndromes: 15,593 patient-years study. Ren Fail 2020; 42:881-889. [PMID: 32862755 PMCID: PMC7472470 DOI: 10.1080/0886022x.2020.1810069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Coexistence of chronic kidney disease (CKD) in the case of acute coronary syndromes (ACS) significantly worsens the outcomes. Aim The aim of our study was to assess renal function impact on mortality among patients with ACS. Materials and methods The study was based on records of 21,985 patients hospitalized in the Medical University of Bialystok in 2009–2015. Inclusion criteria were ACS. Exclusion criteria were: death within 24 h of admission, eGFR <15 ml/min/1.73 m2, hemodialysis. Mean observation time was 2296 days. Results Criteria were met by 2213 patients. CKD occurred in 24.1% (N = 533) and more often affected those with NSTEMI (26.2 (337) vs. 21.2 (196), p = .006). STEMI patients had higher incidence of post-contrast acute kidney injury (PC-AKI) (5 (46) vs. 4.1 (53), p < .001). During the study, 705 people died (31.9%), more often with NSTEMI (33.2% (428) vs. 29.95% (277), p < .001). However, from a group of patients suffering from PC-AKI 57.6% died. The risk of PC-AKI increased with creatinine concentration (RR: 2.990, 95%CI: 1.567–5.721, p < .001), occurrence of diabetes mellitus (RR: 2.143, 95%CI: 1.029–4.463, p = .042), atrial fibrillation (RR: 2.289, 95%CI: 1.056–4.959, p = .036). Risk of death was greater with an increase in postprocedural creatinine concentration (RR: 2.254, 95%CI: 1.481–3.424, p < .001). Conclusion PC-AKI is a major complication in patients with ACS, occurs more frequently in STEMI and may be a prognostic marker of long-term mortality in patients undergoing percutaneous coronary intervention (PCI). More attention should be given to the prevention and diagnosis of PC-AKI but necessary PCI should not be withheld in fear of PC-AKI.
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Affiliation(s)
- Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Jolanta Małyszko
- Department of Clinical Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Anna Kurasz
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Marta Maria Niwińska
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | | | - Hanna Bachórzewska-Gajewska
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland.,Department of Clinical Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
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9
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Burlacu A, Genovesi S, Basile C, Ortiz A, Mitra S, Kirmizis D, Kanbay M, Davenport A, van der Sande F, Covic A. Coronary artery disease in dialysis patients: evidence synthesis, controversies and proposed management strategies. J Nephrol 2020; 34:39-51. [PMID: 32472526 DOI: 10.1007/s40620-020-00758-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/23/2020] [Indexed: 12/31/2022]
Abstract
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality among patients with end-stage renal disease (ESRD). Clustering of traditional atherosclerotic and non-traditional risk factors drive the excess rates of coronary and non-coronary CVD in this population. The incidence, severity and mortality of coronary artery disease (CAD) as well as the number of complications of its therapy is higher in dialysis patients than in non-chronic kidney disease patients. Given the lack of randomized clinical trial evidence in this population, current practice is informed by observational data with a significant potential for bias. Furthermore, guidelines lack any recommendation for these patients or extrapolate them from trials performed in non-dialysis patients. Patients with ESRD are more likely to be asymptomatic, posing a challenge to the correct identification of CAD, which is essential for appropriate risk stratification and management. This may lead to "therapeutic nihilism", which has been associated with worse outcomes. Here, the ERA-EDTA EUDIAL Working Group reviews the diagnostic work-up and therapy of chronic coronary syndromes, unstable angina/non-ST elevation and ST-elevation myocardial infarction in dialysis patients, outlining unclear issues and controversies, discussing recent evidence, and proposing management strategies. Indications of antiplatelet and anticoagulant therapies, percutaneous coronary intervention and coronary artery bypass grafting are discussed. The issue of the interaction between dialysis session and myocardial damage is also addressed.
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Affiliation(s)
- Alexandru Burlacu
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, and 'Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Simonetta Genovesi
- Nephrology Unit, San Gerardo Hospital, Monza, Italy, University of Milan-Bicocca, Milan, Italy
| | - Carlo Basile
- Division of Nephrology, Miulli General Hospital, Via Battisti 192, Acquaviva delle Fonti, 74121, Taranto, Italy. .,Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy.
| | - Alberto Ortiz
- FRIAT and REDINREN, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
| | - Sandip Mitra
- Manchester Academy of Health Sciences Centre, Manchester University Hospitals Foundation Trust and University of Manchester, Oxford Road, Manchester, UK
| | | | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
| | - Andrew Davenport
- Division of Medicine, UCL Centre for Nephrology, Royal Free Hospital, University College London, London, UK
| | - Frank van der Sande
- Division of Nephrology, Department of Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center-'C.I. Parhon' University Hospital, and 'Grigore T. Popa' University of Medicine, Iasi, Romania.,The Academy of Romanian Scientists (AOSR), Bucharest, Romania
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