Effect of late revascularization of a totally occluded coronary artery after myocardial infarction on mortality rates in patients with renal impairment.
Renal dysfunction is an independent predictor of cardiovascular events and a negative prognostic indicator after myocardial infarction (MI). Randomized data comparing percutaneous coronary intervention to medical therapy in patients with MI with renal insufficiency are needed. The Occluded Artery Tr...
| Publicado en: | American Journal of Cardiology Vol. 110; no. 7; pp. 954 - 961 |
|---|---|
| Autores principales: | , , , , , , , , , , , , , , , , , , , |
| Formato: | research randomized controlled trial Journal Article |
| Publicado: |
Elsevier B.V.
Oct2012
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104366660&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104366660 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00029149 AJD jtl: American Journal of Cardiology issn: 00029149 maglogo: N pubinfo: dt: Oct2012 vid: 110 iid: 7 pid: 82545 pub: Elsevier B.V. place: Philadelphia, Pennsylvania artinfo: ui: 104366660 NLM22728005 2011681648 10.1016/j.amjcard.2012.05.024 NLM22728005 PMC3439588 104366660 ppf: 954 ppct: 7 formats: tig: atl: Effect of late revascularization of a totally occluded coronary artery after myocardial infarction on mortality rates in patients with renal impairment. aug: au: Hastings RS Hochman JS Dzavik V Lamas GA Forman SA Schiele F Michalis LK Nikas D Jaroch J Reynolds HR Hastings, Ramin S Hochman, Judith S Dzavik, Vladimir Lamas, Gervasio A Forman, Sandra A Schiele, Francois Michalis, Lampros K Nikas, Dimitris Jaroch, Joanna Reynolds, Harmony R affil: Cardiovascular Clinical Research Center, Division of Cardiology, New York University School of Medicine, New York, New York, USA sug: subj: Coronary Stenosis Surgery Myocardial Infarction Complications Myocardial Revascularization Methods Renal Insufficiency Mortality Aged Coronary Angiography Coronary Stenosis Etiology Coronary Stenosis Radiography Female Glomerular Filtration Rate Human Male Middle Age Myocardial Infarction Diagnosis Myocardial Infarction Surgery Prognosis Prospective Studies Randomized Controlled Trials Renal Insufficiency Complications Renal Insufficiency Diagnosis Retrospective Design Risk Factors Severity of Illness Indices Time Factors Aged: 65+ years Middle Aged: 45-64 years Female Male ab: Renal dysfunction is an independent predictor of cardiovascular events and a negative prognostic indicator after myocardial infarction (MI). Randomized data comparing percutaneous coronary intervention to medical therapy in patients with MI with renal insufficiency are needed. The Occluded Artery Trial (OAT) compared optimal medical therapy alone to percutaneous coronary intervention with optimal medical therapy in 2,201 high-risk patients with occluded infarct arteries >24 hours after MI with serum creatinine levels ≤2.5 mg/dl. The primary end point was a composite of death, MI, and class IV heart failure (HF). Analyses were carried out using estimated glomerular filtration rate (eGFR) as a continuous variable and by eGFR categories. Long-term follow-up data (maximum 9 years) were used for this analysis. Lower eGFR was associated with development of the primary outcome (6-year life-table rates of 16.9% for eGFR >90 ml/min/1.73 m(2), 19.2% for eGFR 60 to 89 ml/min/1.73 m(2), and 34.9% for eGFR <60 ml/min/1.73 m(2); p <0.0001), death, and class IV HF, with no difference in rates of reinfarction. On multivariate analysis, eGFR was an independent predictor of death and HF. There was no effect of treatment assignment on the primary end point regardless of eGFR, and there was no significant interaction between eGFR and treatment assignment on any outcome. In conclusion, lower eGFR at enrollment was independently associated with death and HF in OAT participants. Despite this increased risk, the lack of benefit from percutaneous coronary intervention in the overall trial was also seen in patients with renal dysfunction and persistent occlusion of the infarct artery in the subacute phase after MI. pubtype: Academic Journal doctype: research randomized controlled trial Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|