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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.

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2009. Vol. 120, no 10, 851-858 p.
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Medical and Health Sciences
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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: 2017-12-12Bibliographically approved

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Wallentin, Lars

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