Prognosis by Renal Function With or Without Percutaneous Coronary Intervention in Non-ST-Segment Elevation Myocardial Infarction.

BACKGROUND

Renal dysfunction increases adverse outcomes in non-ST-segment elevation myocardial infarction (NSTEMI), but evidence comparing percutaneous coronary intervention (PCI) with non-PCI by renal function is limited.

OBJECTIVES

The authors aimed to compare 3-year outcomes of PCI versus non-PCI by baseline renal function in NSTEMI.

METHODS

We stratified 15,255 NSTEMI patients by estimated glomerular filtration rate (eGFR; ≥90, 60-89, 30-59, and <30 mL/min/1.73 m2). Primary outcome was 3-year major adverse cardiac and cerebrovascular events (MACCE; defined as all-cause death, recurrent myocardial infarction, or stroke). Multivariable-adjusted Cox regression was performed. Median follow-up was 36.0 months (IQR: 36.0-36.0 months; 40,097 person-years).

RESULTS

Worsening renal function was associated with higher MACCE and mortality (all P < 0.001), except between eGFR ≥90 and 60-89. Compared with non-PCI, PCI was associated with lower adjusted risks in the eGFR 60-89, 30-59, and <30 strata, respectively, regarding MACCE (HR [95% CI]: 0.58 [0.47-0.71]; 0.66 [0.53-0.82]; 0.60 [0.48-0.75]), all-cause mortality (HR [95% CI]: 0.47 [0.37-0.60]; 0.57 [0.45-0.72]; 0.59 [0.47-0.76]), and cardiovascular mortality (HR [95% CI]: 0.48 [0.34-0.66]; 0.53 [0.39-0.70]; 0.56 [0.41-0.75]) (all P < 0.001), but not in eGFR ≥90 MACCE (HR: 0.83 [95% CI: 0.64-1.07]; P = 0.158). Significant interaction was observed only for all-cause mortality (P = 0.044).

CONCLUSIONS

In NSTEMI, worsening renal function was associated with higher long-term adverse outcomes. PCI was associated with lower risks across most renal function strata, but not in eGFR ≥90.