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Influence of renal function on the effects of early revascularization in non-ST-elevation myocardial infarction: data from the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART)
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2009 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 120, no 10, 851-858 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: It is unknown whether patients with non-ST-elevation myocardial infarction derive a similar benefit from an early invasive therapy at different levels of renal function. METHODS AND RESULTS: A total of 23 262 consecutive non-ST-elevation myocardial infarction patients or=90 mL . min(-1) . 1.73 m(-2), 62%; eGFR 60 to 89 mL . min(-1) . 1.73 m(-2), 55%; eGFR 30 to 59 mL . min(-1) . 1.73 m(-2), 36%; eGFR 15 to 29 mL . min(-1) . 1.73 m(-2), 14%; and eGFR <15 mL . min(-1) . 1.73 m(-2)/dialysis, 15% (P<0.001). After adjustment, the overall 1-year mortality was 36% lower (hazard ratio 0.64, 95% confidence interval 0.56 to 0.73, P<0.001) with an invasive strategy. The magnitude of survival difference was similar in normal-to-moderate renal function groups. The lower mortality observed with invasive therapy declined with lower renal function, with no difference in mortality in patients with kidney failure (eGFR <15 mL . min(-1) . 1.73 m(-2)) or in those receiving dialysis (hazard ratio 1.61, 95% confidence interval 0.84 to 3.09, P=0.15). CONCLUSIONS: Early invasive therapy is associated with greater 1-year survival in patients with non-ST-elevation myocardial infarction and mild-to-moderate renal insufficiency, but the benefit declines with lower renal function, and is less certain in those with renal failure or on dialysis.

Place, publisher, year, edition, pages
2009. Vol. 120, no 10, 851-858 p.
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Medical and Health Sciences
URN: urn:nbn:se:uu:diva-124190DOI: 10.1161/CIRCULATIONAHA.108.838169ISI: 000269633700006PubMedID: 19704097OAI: oai:DiVA.org:uu-124190DiVA: diva2:317208
Available from: 2010-05-03 Created: 2010-05-03 Last updated: 2012-07-13Bibliographically approved

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