PMID- 21040324 OWN - NLM STAT- MEDLINE DCOM- 20130521 LR - 20181201 IS - 1445-5994 (Electronic) IS - 1444-0903 (Linking) VI - 41 IP - 10 DP - 2011 Oct TI - An invasive management strategy is associated with improved outcomes in high-risk acute coronary syndromes in patients with chronic kidney disease. PG - 743-50 LID - 10.1111/j.1445-5994.2010.02361.x [doi] AB - INTRODUCTION: Chronic kidney disease (CKD) is associated with poor outcomes after acute coronary syndromes, yet selection for invasive investigation and management is low. METHODS: Patients presenting with ST segment elevation myocardial infarction (STEMI) or intermediate- to high-risk non-ST segment elevation acute coronary syndrome (NSTEACS) (n=2597) were stratified into groups based on kidney function, defined as normal (glomerular filtration rate (GFR)>/=60mL/min/1.73m(2) ), moderate CKD (GFR 30-59mL/min/1.73m(2) ) and severe CKD (GFR <30mL/min/1.73m(2)). Based on these stratums of kidney function, incidence and outcome measures were obtained for: rates of angiography and revascularization; 6-month mortality; and the incidence and outcome of in-hospital acute kidney impairment (AKI). RESULTS: Patients with CKD were less likely to be offered coronary angiography after STEMI/NSTEACS (P<0.001); however, after selection, revascularization rates were similar (percutaneous coronary intervention (P=0.8); surgery (P=0.4)). Six-month mortality rates increased with CKD (GFR>/=60, 2.8%; GFR 30-59, 9.9%; GFR<30, 16.5%, P/=60, 9.4%; GFR 30-59, 20.2%; GFR<30, 27.1%, P/=60, 1.5% vs 3.6%, P=0.001; GFR 30-59, 5.1% vs 12.7%, P<0.001; GFR<30, 7.3% vs 18.5%, P=0.094). Risk of AKI increased with CKD (GFR>/=60, 0.7%; GFR 30-59, 3.4%; GFR<30, 6.8%, P