Shuvy Mony, Chen Shmuel, Vorobeichik Dina, Krashin Eilon, Shlomo Nir, Goldenberg Ilan, Pereg David
Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Int J Cardiol. 2017 Apr 1;232:48-52. doi: 10.1016/j.ijcard.2017.01.053. Epub 2017 Jan 5.
Recent new therapeutic options have improved outcomes of acute coronary syndrome (ACS) patients. However, data regarding the incremental effect of the improved treatment on patients with renal dysfunction are limited. We sought to evaluate temporal trends in management and outcome of ACS patients according to renal function.
The study population consisted of all ACS patients enrolled in the Acute Coronary Syndromes Israeli Survey (ACSIS) during 2002-2013. Patients were categorized as normal renal function, mild to moderate and severe renal insufficiency. Patient's characteristics, clinical data and outcomes were compared in each group between 2 time frames - early (2002-2006) vs. late (2008-2013).
The study population included 11,234 patients. Regardless of renal function, patients enrolled in the recent surveys were more frequently selected for an invasive approach and were more commonly treated with guideline-based therapy. Among patients with normal renal function or mild to moderate renal dysfunction the improvement in treatment was associated with a significant reduction in 5-year mortality (10.1% vs. 12.6%, p=0.004, and 36% vs. 41.9%, p=0.01, respectively). On the other hand, outcomes of patients with severe renal insufficiency were unchanged. Multivariate analysis showed that reperfusion was associated with 41% mortality reduction in patients with mild to moderate renal insufficiency (HR=0.59 CI 95 0.48-0.72, p<0.01%).
Treatment of ACS patients has improved over the past decade. Treatment improvement was associated with a significant mortality reduction in patients with normal renal function and mild to moderate renal dysfunction but not in patients with severe renal dysfunction.
近期新的治疗选择改善了急性冠脉综合征（ACS）患者的预后。然而，关于改善治疗对肾功能不全患者的增量效应的数据有限。我们试图根据肾功能评估ACS患者管理和预后的时间趋势。
研究人群包括2002年至2013年期间纳入以色列急性冠脉综合征调查（ACSIS）的所有ACS患者。患者被分类为肾功能正常、轻度至中度和重度肾功能不全。在两个时间框架内（早期[2002 - 2006年]与晚期[2008 - 2013年]）对每组患者的特征、临床数据和预后进行比较。
研究人群包括11234名患者。无论肾功能如何，近期调查中纳入的患者更常被选择采用侵入性治疗方法，并且更常接受基于指南的治疗。在肾功能正常或轻度至中度肾功能不全的患者中，治疗的改善与5年死亡率的显著降低相关（分别为10.1%对12.6%，p = 0.004，以及36%对41.9%，p = 0.01）。另一方面，重度肾功能不全患者的预后没有变化。多变量分析显示，再灌注与轻度至中度肾功能不全患者死亡率降低41%相关（HR = 0.59，95%CI 0.48 - 0.72，p < 0.01%）。
在过去十年中，ACS患者的治疗有所改善。治疗改善与肾功能正常和轻度至中度肾功能不全患者的死亡率显著降低相关，但与重度肾功能不全患者无关。
