Chronic kidney disease in patients with non-ST-segment elevation acute coronary syndromes

被引:92
作者
Han, JH
Chandra, A
Mulgund, J
Roe, MT
Peterson, ED
Szczech, LA
Patel, U
Ohman, EM
Lindsell, CJ
Gibler, WB
机构
[1] Univ Cincinnati, Sch Med, Dept Emergency Med, Cincinnati, OH USA
[2] Univ Cincinnati, Sch Med, Inst Hlth Policy, Cincinnati, OH USA
[3] Univ Cincinnati, Sch Med, Hlth Serv Res, Cincinnati, OH USA
[4] Duke Univ, Med Ctr, Dept Emergency Med, Durham, NC USA
[5] Duke Univ, Med Ctr, Div Nephrol, Durham, NC USA
[6] Duke Univ, Med Ctr, Div Cardiol, Durham, NC 27710 USA
[7] Duke Univ, Med Ctr, Duke Clin Res Inst, Durham, NC 27710 USA
[8] Univ N Carolina, Sch Med, Chapel Hill, NC USA
关键词
chronic kidney disease; acute coronary syndromes; quality improvement; guidelines;
D O I
10.1016/j.amjmed.2005.08.057
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
PURPOSE: Chronic kidney disease has been linked to high mortality rates in patients with ST-segment elevation myocardial infarction but has not been well described for patients with non-ST-segment elevation acute coronary syndromes. We examined the treatment and outcomes of patients with both non-ST-segment elevation acute coronary syndromes and moderate to severe chronic kidney disease. SUBJECTS AND METHODS: We evaluated 45343 patients with non-ST-segment elevation acute coronary syndromes enrolled in the CRUSADE Quality Improvement Initiative and compared treatments and outcomes in patients with and without moderate to severe chronic kidney disease. RESULTS: Patients presenting with moderate to severe chronic kidney disease (n = 6560) were older, more often diabetic, and more likely to present with signs of congestive heart failure. Adherence to Class IA/IB guidelines recommendations was lower in patients with moderate to severe chronic kidney disease, who were significantly less likely to be treated with medications, undergo invasive cardiac procedures, and be given discharge counseling. Moderate to severe chronic kidney disease was associated with a 50% increased risk of mortality and a 70% increased likelihood of transfusion. Despite having a higher risk of adverse outcomes, patients with moderate to severe chronic kidney disease were treated less aggressively than patients with normal renal function. CONCLUSIONS: These findings suggest that, in patients with moderate to severe chronic kidney disease, safety concerns about adverse outcomes and the absence of trial data for this population may limit the use of guidelines-recommended therapies and interventions for non-ST-segment elevation acute coronary syndromes. The decreased use of discharge counseling in patients with moderate to severe chronic kidney disease and non-ST-segment elevation acute coronary syndromes may represent therapeutic nihilism. (c) 2006 Elsevier Inc. All rights reserved.
引用
收藏
页码:248 / 254
页数:7
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