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Inpatient Coronary Angiography and Revascularisation following Non-ST-Elevation Acute Coronary Syndrome in Patients with Renal Impairment: A Cohort Study Using the Myocardial Ischaemia National Audit Project

Catriona Shaw, Dorothea Nitsch, Retha Steenkamp, Cornelia Junghans, Sapna Shah, Donal O’Donoghue, Damian Fogarty, Clive Weston Orcid Logo, Claire C. Sharpe

PLoS ONE, Volume: 9, Issue: 6, Start page: e99925

Swansea University Author: Clive Weston Orcid Logo

DOI (Published version): 10.1371/journal.pone.0099925

Abstract

Guidelines support early invasive management that includes coronary angiography and revascularisation) for non-ST-elevation acute coronary syndrome (NSTE-ACS) in patients with renal impairment. We described NHS practice to determine whether the severity of renal dysfunction influenced the provision...

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Published in: PLoS ONE
Published: 2014
URI: https://cronfa.swan.ac.uk/Record/cronfa18273
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spelling 2016-04-11T14:33:56.2378301 v2 18273 2014-08-25 Inpatient Coronary Angiography and Revascularisation following Non-ST-Elevation Acute Coronary Syndrome in Patients with Renal Impairment: A Cohort Study Using the Myocardial Ischaemia National Audit Project df85e4e0e139d0f46eb683174eba98a9 0000-0002-8995-8199 Clive Weston Clive Weston true false 2014-08-25 PMSC Guidelines support early invasive management that includes coronary angiography and revascularisation) for non-ST-elevation acute coronary syndrome (NSTE-ACS) in patients with renal impairment. We described NHS practice to determine whether the severity of renal dysfunction influenced the provision of angiography and modified the association between early revascularisation and survival.We anaylsed a cohort, using multivariable logistic regression and propensity score analyses, from the Myocardial Ischaemia National Audit Project (MINAP) for patients with NSTE-ACS in England or Wales between 2008 and 2010. Of 35 881 patients diagnosed with NSTE-ACS, eGFR of less than 60 ml/minute/1.73 m2 was present in 15 680 (43.7%).There was a stepwise decline in the odds of undergoing inpatient angiography with worsening renal dysfunction.Compared with an eGFR,of more than 90 ml/minute/1.73 m2, patients with an eGFR between 45–59 ml/minute/1.73 m2 were 33% less likely to undergo angiography (adjusted OR 0.67, 95% CI 0.55–0.81); those with an eGFR less than 30/minute/1.73 m2 had a 64% reduction in odds of undergoing angiography (adjusted OR 0.36, 95%CI 0.29–0.43). Of 16 646 patients who had inpatient coronary angiography, 58.5% underwent inpatient revascularisation. After adjusting for co-variables, inpatient revascularisation was associated with approximately a 30% reduction in death within 1 year compared with thosemanaged medically after coronary angiography (adjusted OR 0.66, 95%CI 0.57–0.77), with no evidence of modification byrenal function (p interaction = 0.744).Early revascularisation offers a similar survival benefit in patients with and without renal dysfunction, yet renal impairment is an important determinant of the provision of coronary angiography following NSTE-ACS. A randomised controlled trial is needed to evaluate the efficacy of an early invasive approach in patients with severe renal dysfunction to ensure that all patients who may benefit are offered this treatment option. Journal Article PLoS ONE 9 6 e99925 Acute coronary syndrome; renal impairment; heart attack; outcome 17 6 2014 2014-06-17 10.1371/journal.pone.0099925 COLLEGE NANME Medicine COLLEGE CODE PMSC Swansea University 2016-04-11T14:33:56.2378301 2014-08-25T12:23:20.5093865 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Catriona Shaw 1 Dorothea Nitsch 2 Retha Steenkamp 3 Cornelia Junghans 4 Sapna Shah 5 Donal O’Donoghue 6 Damian Fogarty 7 Clive Weston 0000-0002-8995-8199 8 Claire C. Sharpe 9 0018273-05032016121756.pdf PLosOne.pdf 2016-03-05T12:17:56.2730000 Output 329901 application/pdf Accepted Manuscript true 2016-03-05T00:00:00.0000000 true
title Inpatient Coronary Angiography and Revascularisation following Non-ST-Elevation Acute Coronary Syndrome in Patients with Renal Impairment: A Cohort Study Using the Myocardial Ischaemia National Audit Project
spellingShingle Inpatient Coronary Angiography and Revascularisation following Non-ST-Elevation Acute Coronary Syndrome in Patients with Renal Impairment: A Cohort Study Using the Myocardial Ischaemia National Audit Project
Clive Weston
title_short Inpatient Coronary Angiography and Revascularisation following Non-ST-Elevation Acute Coronary Syndrome in Patients with Renal Impairment: A Cohort Study Using the Myocardial Ischaemia National Audit Project
title_full Inpatient Coronary Angiography and Revascularisation following Non-ST-Elevation Acute Coronary Syndrome in Patients with Renal Impairment: A Cohort Study Using the Myocardial Ischaemia National Audit Project
title_fullStr Inpatient Coronary Angiography and Revascularisation following Non-ST-Elevation Acute Coronary Syndrome in Patients with Renal Impairment: A Cohort Study Using the Myocardial Ischaemia National Audit Project
title_full_unstemmed Inpatient Coronary Angiography and Revascularisation following Non-ST-Elevation Acute Coronary Syndrome in Patients with Renal Impairment: A Cohort Study Using the Myocardial Ischaemia National Audit Project
title_sort Inpatient Coronary Angiography and Revascularisation following Non-ST-Elevation Acute Coronary Syndrome in Patients with Renal Impairment: A Cohort Study Using the Myocardial Ischaemia National Audit Project
author_id_str_mv df85e4e0e139d0f46eb683174eba98a9
author_id_fullname_str_mv df85e4e0e139d0f46eb683174eba98a9_***_Clive Weston
author Clive Weston
author2 Catriona Shaw
Dorothea Nitsch
Retha Steenkamp
Cornelia Junghans
Sapna Shah
Donal O’Donoghue
Damian Fogarty
Clive Weston
Claire C. Sharpe
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container_title PLoS ONE
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container_issue 6
container_start_page e99925
publishDate 2014
institution Swansea University
doi_str_mv 10.1371/journal.pone.0099925
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
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description Guidelines support early invasive management that includes coronary angiography and revascularisation) for non-ST-elevation acute coronary syndrome (NSTE-ACS) in patients with renal impairment. We described NHS practice to determine whether the severity of renal dysfunction influenced the provision of angiography and modified the association between early revascularisation and survival.We anaylsed a cohort, using multivariable logistic regression and propensity score analyses, from the Myocardial Ischaemia National Audit Project (MINAP) for patients with NSTE-ACS in England or Wales between 2008 and 2010. Of 35 881 patients diagnosed with NSTE-ACS, eGFR of less than 60 ml/minute/1.73 m2 was present in 15 680 (43.7%).There was a stepwise decline in the odds of undergoing inpatient angiography with worsening renal dysfunction.Compared with an eGFR,of more than 90 ml/minute/1.73 m2, patients with an eGFR between 45–59 ml/minute/1.73 m2 were 33% less likely to undergo angiography (adjusted OR 0.67, 95% CI 0.55–0.81); those with an eGFR less than 30/minute/1.73 m2 had a 64% reduction in odds of undergoing angiography (adjusted OR 0.36, 95%CI 0.29–0.43). Of 16 646 patients who had inpatient coronary angiography, 58.5% underwent inpatient revascularisation. After adjusting for co-variables, inpatient revascularisation was associated with approximately a 30% reduction in death within 1 year compared with thosemanaged medically after coronary angiography (adjusted OR 0.66, 95%CI 0.57–0.77), with no evidence of modification byrenal function (p interaction = 0.744).Early revascularisation offers a similar survival benefit in patients with and without renal dysfunction, yet renal impairment is an important determinant of the provision of coronary angiography following NSTE-ACS. A randomised controlled trial is needed to evaluate the efficacy of an early invasive approach in patients with severe renal dysfunction to ensure that all patients who may benefit are offered this treatment option.
published_date 2014-06-17T03:21:23Z
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