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

• Type of Material: Article
• Authors: Akshay Bagai, University of Toronto; Di Lu, Duke University; Joseph Lucas, Duke University; Abhinav Goyal, Emory University; Charles A. Herzog, University of Minnesota; Tracy Y. Wang, Duke University; Shaun G. Goodman, University of Toronto; Matthew T. Roe, Duke University
• Language: English
• Date: 2018-12-18
• Publisher: Wiley Open Access: Creative Commons Attribution Non-Commercial
• Publication Version: Final Published Version
• Copyright Statement: © 2018 The Authors.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.118.010394
• Title of Journal or Parent Work: Journal of the American Heart Association
• ISSN: 2047-9980
• Volume: 7
• Issue: 24
• Start Page: e010394
• End Page: e010394
• Grant/Funding Information: This research was supported by the American College of Cardiology Foundation's NCDR (National Cardiovascular Data Registry).
• Keywords: CLOPIDOGREL; CLINICAL CHARACTERISTICS; Science & Technology; myocardial infarction; NATIONAL-REGISTRY; INTERVENTION; UNITED-STATES; ACUTE CORONARY SYNDROME; COLLABORATIVE PROJECT; outcomes research; Cardiovascular System & Cardiology; Life Sciences & Biomedicine; chronic kidney disease; TERM OUTCOMES; RENAL-FUNCTION; STATIN THERAPY; Cardiac & Cardiovascular Systems
• Research Categories: Health Sciences, Public Health

Abstract

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 2 ] not requiring dialysis, and no CKD [glomerular filtration rate ≥60 mL/min per 1.73 m 2 ]). 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 12 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.