Temporal trends in management and outcomes of patients with acute coronary syndrome according to renal function
| Autor: | Nir Shlomo, Mony Shuvy, Eilon Krashin, Shmuel Chen, Ilan Goldenberg, David Pereg, Dina Vorobeichik |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Acute coronary syndrome medicine.medical_specialty Multivariate analysis 030232 urology & nephrology Renal function 030204 cardiovascular system & hematology Kidney 03 medical and health sciences Normal renal function 0302 clinical medicine Risk Factors Internal medicine Cause of Death medicine Humans In patient Hospital Mortality Renal Insufficiency Acute Coronary Syndrome Israel Intensive care medicine Aged Retrospective Studies business.industry Mortality reduction Disease Management Guideline medicine.disease Prognosis Survival Rate Creatinine Population study Female Cardiology and Cardiovascular Medicine business Glomerular Filtration Rate |
| Zdroj: | International journal of cardiology. 232 |
| ISSN: | 1874-1754 |
| Popis: | Introduction Recent new therapeutic options have improved outcomes of acute coronary syndrome (ACS) patients. However, data regarding the incremental effect of the improved treatment on patients with renal dysfunction are limited. We sought to evaluate temporal trends in management and outcome of ACS patients according to renal function. Methods The study population consisted of all ACS patients enrolled in the Acute Coronary Syndromes Israeli Survey (ACSIS) during 2002–2013. Patients were categorized as normal renal function, mild to moderate and severe renal insufficiency. Patient's characteristics, clinical data and outcomes were compared in each group between 2 time frames - early (2002–2006) vs. late (2008–2013). Results The study population included 11,234 patients. Regardless of renal function, patients enrolled in the recent surveys were more frequently selected for an invasive approach and were more commonly treated with guideline-based therapy. Among patients with normal renal function or mild to moderate renal dysfunction the improvement in treatment was associated with a significant reduction in 5-year mortality (10.1% vs. 12.6%, p=0.004, and 36% vs. 41.9%, p=0.01, respectively). On the other hand, outcomes of patients with severe renal insufficiency were unchanged. Multivariate analysis showed that reperfusion was associated with 41% mortality reduction in patients with mild to moderate renal insufficiency (HR=0.59 CI 95 0.48–0.72, p Conclusions Treatment of ACS patients has improved over the past decade. Treatment improvement was associated with a significant mortality reduction in patients with normal renal function and mild to moderate renal dysfunction but not in patients with severe renal dysfunction. |
| Databáze: | OpenAIRE |
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