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Prior studies showed that early invasive intervention might improve outcomes for high-risk patients with Non-ST elevation Acute Coronary Syndromes (NSTEACS), however the optimal timing of invasive intervention in patients with NSTEACS and End Stage Renal Disease (ERSD) remains inconclusive. The purpose of this study was to evaluate the clinical impact of early versus delayed percutaneous coronary intervention (PCI) in patients with ESRD hospitalized with NSTEACS.
We conducted a nationwide retrospective cohort study utilizing the National Inpatient Sample from 2010 to 2014. Adult patients with ESRD who underwent PCI for NSTEACS were included in the study. Patients were assigned to either early PCI group (PCI performed within 24 hours of hospitalization) or delayed PCI group (PCI performed after 24 hours). The primary outcome was in-hospital mortality. The secondary outcomes included mean length of stay (LOS), intensive care unit (ICU) admission, shock, acute respiratory failure and non-fatal major bleeding. Multivariable regression analysis was used to adjust for potential confounders including gender, age, Charlson Comorbidity Index, hospital bed size, hospital location and teaching status of hospital.
A total of 26,505 patients were included in our study, and 48.5% of patients (12846) underwent early PCI. There was no statistical difference in age between the two groups (mean 64.9 vs 65.4 years, p>0.05). Compared with delayed PCI group, early PCI group had statistically higher in-hospital mortality rate (5.7% vs 3.5%, adjusted Odds Ratio [OR] 1.7, p<0.001), lower mean LOS (5.0 vs 8.3 days, adjusted β -3.3, p<0.001) and lower rate of non-fatal major bleeding (1.4% vs 3.0%, adjusted OR 0.5, p=0.001). There were no statistical differences in the rates of ICU admission (7.6% vs 8.9%), shock (0.65% vs 0.95%) or acute respiratory failure (12.8% vs 14.9%) (all p>0.05).
PCI within 24 hours of hospitalization was associated higher in-hospital mortality rate, shorter LOS and lower non-fatal major bleeding rate in patients with ESRD and NSTEACS. In clinical practice, high-risk patients tended to undergo PCI earlier compared with low-risk patients, which might lead to the higher in-hospital mortality rate in the early PCI group in our study. A prospective randomized controlled study is required to evaluate the optimal timing of invasive intervention in patients with ESRD and NSTEACS.
CORONARY: Acute Coronary Syndromes