Background

Current guidelines suggest that an early invasive strategy should be considered for the treatment of non–ST-segment elevation myocardial infarction (NSTEMI). Although chronic kidney disease (CKD) is common among NSTEMI patients, these patients are under-represented in clinical trials, and data regarding their management are limited.

Objectives

The authors sought to evaluate the association between early invasive strategy and long-term survival among patients with NSTEMI and CKD.

Methods

This was a retrospective analysis of 7,107 consecutive NSTEMI patients between 2008 and 2021. Patients were dichotomized into early (≤24 hours) and delayed invasive groups and stratified by kidney function. Inverse probability treatment weighting was used to adjust for differences in baseline characteristics. The primary outcome was all-cause mortality.

Results

The final study population comprised 3,529 invasively treated patients with a median age of 66 years (IQR: 58-74 years), 1,837 (52%) of whom were treated early. There were 483 (14%) patients with at least moderate CKD (estimated glomerular filtration rate [eGFR] <45 mL/min/1.73 m²). During a median follow-up of 4 years (IQR: 2-6 years), 527 (15%) patients died. After inverse probability treatment weighting, an early invasive strategy was associated with a significant 30% lower mortality compared with a delayed strategy (HR: 0.7; 95% CI: 0.56-0.85). The association between early invasive strategy and mortality was modified by eGFR (P_interaction < 0.001) and declined with lower renal function, with no difference in mortality among patients with eGFR <45 mL/min/1.73 m² (HR: 0.89; 95% CI: 0.64-1.24).

Conclusions

Among NSTEMI patients, the association of early invasive strategy with long-term survival is modified by CKD and was not observed in patients with eGFR <45 mL/min/1.73 m².

中文翻译：

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慢性肾病非ST段抬高心肌梗死患者的早期侵入性策略和结果

背景

目前的指南建议应考虑早期侵入性策略来治疗非 ST 段抬高型心肌梗死 (NSTEMI)。尽管慢性肾病 (CKD) 在 NSTEMI 患者中很常见，但这些患者在临床试验中的代表性不足，有关其治疗的数据有限。

目标

作者试图评估 NSTEMI 和 CKD 患者的早期侵入性策略与长期生存之间的关联。

方法

这是对 2008 年至 2021 年间连续 7,107 名 NSTEMI 患者的回顾性分析。患者分为早期（≤24 小时）和延迟浸润组，并按肾功能分层。逆概率治疗加权用于调整基线特征的差异。主要结局是全因死亡率。

结果

最终研究人群包括 3,529 名接受侵入性治疗的患者，中位年龄为 66 岁（IQR：58-74 岁），其中 1,837 人（52%）接受了早期治疗。有 483 名 (14%) 患者至少患有中度 CKD（估计肾小球滤过率 [eGFR] <45 mL/min/1.73 m ²）。在 4 年的中位随访期间（IQR：2-6 年），527 名（15%）患者死亡。在逆概率治疗加权后，与延迟策略相比，早期侵入性策略与死亡率显着降低 30% 相关（HR：0.7；95% CI：0.56-0.85）。eGFR 改变了早期侵入性策略与死亡率之间的关联（P_交互作用 < 0.001）并随着肾功能降低而下降，eGFR <45 mL/min/1.73 m 患者的死亡率没有差异²（HR：0.89；95% CI：0.64-1.24）。

结论

在 NSTEMI 患者中，早期侵入性策略与长期生存的关联因 CKD 而改变，而在 eGFR <45 mL/min/1.73 m ²的患者中未观察到。