American heart journal · 2002
Benefits of aspirin and beta-blockade after myocardial infarction in patients with chronic kidney disease.
Оценочное исследованиеСтатьяНазвание и аннотация: Перевод в очереди
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McCullough Peter A, Sandberg Keisha R, Borzak Steven, Hudson Michael P, Garg Mukesh, Manley Harold J
Аннотация
BACKGROUND: There have been no randomized trials of cardioprotective therapy after acute myocardial infarction in patients with chronic kidney disease who should be largely eligible for aspirin (acetylsalicylic acid; ASA) and beta-blockers (BB) as a base of therapy.
METHODS: We analyzed a prospective coronary care unit registry of 1724 patients with ST-segment elevation myocardial infarction.
RESULTS: Usage rates were 52.3%, 19.0%, 15.2%, and 13.5% for ASA and BB (ASA+BB), BB alone, ASA alone, and no ASA or BB therapy. Patients who received ASA+BB were more likely to be male, free of earlier cardiac disease, and recipients of thrombolysis. Conversely, the absence of ASA+BB was observed in patients with heart failure on admission, left bundle branch block, atrial and ventricular arrhythmias, and shock. The combination of ASA+BB was used in 63.9%, 55.8%, 48.2%, and 35.5% of patients with corrected creatinine clearance values of >81.5, 81.5 to 63.1, 63.1 to 46.2, and <46.2 mL/min/72 kg (P <.0001). ASA+BB was used in 40.4% of patients undergoing dialysis. The age-adjusted relative risk reduction for the inhospital mortality rate was similar among all renal groups and ranged from 64.3% to 80.0% (all P <.0001).
CONCLUSION: ASA+BB is an underused therapy in patients with acute myocardial infarction who have underlying kidney disease.
METHODS: We analyzed a prospective coronary care unit registry of 1724 patients with ST-segment elevation myocardial infarction.
RESULTS: Usage rates were 52.3%, 19.0%, 15.2%, and 13.5% for ASA and BB (ASA+BB), BB alone, ASA alone, and no ASA or BB therapy. Patients who received ASA+BB were more likely to be male, free of earlier cardiac disease, and recipients of thrombolysis. Conversely, the absence of ASA+BB was observed in patients with heart failure on admission, left bundle branch block, atrial and ventricular arrhythmias, and shock. The combination of ASA+BB was used in 63.9%, 55.8%, 48.2%, and 35.5% of patients with corrected creatinine clearance values of >81.5, 81.5 to 63.1, 63.1 to 46.2, and <46.2 mL/min/72 kg (P <.0001). ASA+BB was used in 40.4% of patients undergoing dialysis. The age-adjusted relative risk reduction for the inhospital mortality rate was similar among all renal groups and ranged from 64.3% to 80.0% (all P <.0001).
CONCLUSION: ASA+BB is an underused therapy in patients with acute myocardial infarction who have underlying kidney disease.
Предметные рубрики MeSH
AdolescentAdrenergic beta-AntagonistsAdultAgedAged, 80 and overAspirinCardiovascular DiseasesChi-Square DistributionComorbidityDiabetes MellitusDrug Therapy, CombinationFemaleHumansKidney Failure, ChronicLogistic ModelsMaleMiddle AgedMyocardial InfarctionRegistriesRetrospective StudiesRisk AssessmentTreatment Outcome