Jeyaruban, A., Hoy, W., Cameron, A., Healy, H., Wang, Z., Zhang, J., and Mallett, A. (2022) Determining the association between the type of intervention for ischaemic heart disease and mortality and morbidity in patients with chronic kidney disease. Internal Medicine Journal, 52 (7). pp. 1190-1195.

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Abstract

Introduction: Association between chronic kidney disease (CKD) and ischaemic heart disease (IHD) is well known. Clinically, because of the use of intra-arterial contrast, coronary angiograms are sometimes not performed to avoid further deterioration in kidney function amongst CKD patients. Therefore, our aim is to identify whether intervention for non-ST elevation myocardial infarction (NStemi) is associated with increased mortality or further renal deterioration.

Method: A retrospective observational cohort study was undertaken involving 144 patients with diagnosis of IHD in the CKD.QLD registry from May 2011 to August 2017, with minimum of 2 years follow-up. Patients were divided into two groups based on whether they obtained an interventional or medical management for NStemi.

Results: 59 patients had medical management and 85 patients had intervention for IHD.

Patients in the medical management group were observed to be significantly older (median:78vs69years,p<0.05) with worse baseline renal function (median:31vs36ml/min/1.73m3,<0.05) and higher serum urate level (median:0.5vs0.4mmol/L,p=0.2). The interventional group had lower prevalence of diabetes, dyslipidaemia, cerebrovascular disease and peripheral vascular disease, , although this was not significant Kaplan-Meier analysis revealed a significant decrease in mean survival of medically managed group compared to interventional group. Furthermore, post adjustment for age and above comorbidities, medically managed group and higher age were associated with significantly higher mortality. However, the patients in the medically managed and interventional groups had no significant difference in delta eGFR.

Conclusion: In this observational study, intervention for IHD was associated with increased survival with no change in renal disease progression in comparison to medically managed patients.

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