Temporal Trends in Utilization of Cardiac Therapies and Outcomes for Myocardial Infarction by Degree of Chronic Kidney Disease: A Report From the NCDR Chest Pain-MI Registry

• Published in: Journal of the American Heart Association Vol. 7; no. 24; p. e010394
• Main Authors: Bagai, Akshay, Lu, Di, Lucas, Joseph, Goyal, Abhinav, Herzog, Charles A, Wang, Tracy Y, Goodman, Shaun G, Roe, Matthew T
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 18.12.2018; Wiley
• Subjects: Aged; Aged, 80 and over; Cardiovascular Agents - adverse effects; Cardiovascular Agents - therapeutic use; chronic kidney disease; Coronary Angiography - trends; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - mortality; Coronary Artery Bypass - trends; Drug Utilization - trends; Female; Glomerular Filtration Rate; Hospital Mortality - trends; Humans; Kidney - physiopathology; Male; Middle Aged; myocardial infarction; Non-ST Elevated Myocardial Infarction - diagnosis; Non-ST Elevated Myocardial Infarction - mortality; Non-ST Elevated Myocardial Infarction - therapy; Original Research; outcomes research; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - mortality; Percutaneous Coronary Intervention - trends; Practice Patterns, Physicians' - trends; Registries; Renal Dialysis - adverse effects; Renal Dialysis - mortality; Renal Dialysis - trends; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - mortality; Renal Insufficiency, Chronic - physiopathology; Renal Insufficiency, Chronic - therapy; Risk Factors; Severity of Illness Index; ST Elevation Myocardial Infarction - diagnosis; ST Elevation Myocardial Infarction - mortality; ST Elevation Myocardial Infarction - therapy; Time Factors; Treatment Outcome; United States - epidemiology; United States; chronic kidney disease; myocardial infarction; outcomes research
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.118.010394

Background We sought to determine temporal trends in use of evidence-based therapies and clinical outcomes among myocardial infarction ( MI) patients with chronic kidney disease ( CKD ). Methods and Results MI patients from the NCDR (National Cardiovascular Data Registry) Chest Pain- MI Registry between January 2007 and December 2015 were categorized into 3 groups by degree of CKD (end-stage renal disease on dialysis, CKD [glomerular filtration rate <60 mL/min per 1.73 m ] not requiring dialysis, and no CKD [glomerular filtration rate ≥60 mL/min per 1.73 m ]). Logistic regression modeling was used to determine the association between calendar years (2014-2015 versus 2007-2008) and each outcome by degree of CKD . Among 325 396 patients with ST-segment-elevation MI, 1.0% had end-stage renal disease requiring dialysis, and 26.1% had CKD not requiring dialysis. Use of primary percutaneous coronary intervention increased over time regardless of the presence or degree of CKD ( P=0.40 for interaction). In-hospital mortality was temporally higher among patients with preserved renal function (odds ratio: 1.25; 95% confidence interval, 1.13-1.39; P<0.001) but not among patients with CKD ( P=0.035 for interaction). Among 506 876 non-ST-segment-elevation MI patients, 3.4% had end-stage renal disease requiring dialysis, and 34.4% had CKD not requiring dialysis. P2Y inhibitor use within 24 hours increased over time only among dialysis patients ( P for interaction <0.001). Use of coronary angiography and percutaneous coronary intervention also increased, with the greatest increase among dialysis patients ( P for interaction <0.001 and <0.001, respectively). In-hospital mortality was lower, regardless of the presence or degree of CKD ( P=0.64 for interaction). Conclusions Uptake of evidence-based medical and invasive therapies has increased over the past decade among MI patients with CKD , particularly dialysis patients, with improvement of in-hospital mortality observed among patients with non-ST-segment-elevation MI, but not ST-segment-elevation MI, and CKD .