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dc.contributor.authorMedi, Caroline
dc.contributor.authorMontalescot, Gilles
dc.contributor.authorBudaj, Andrzej
dc.contributor.authorFox, Keith A. A.
dc.contributor.authorLopez-Sendon, Jose
dc.contributor.authorFitzgerald, Gordon
dc.contributor.authorBrieger, David
dc.date2022-08-11T08:08:08.000
dc.date.accessioned2022-08-23T15:43:56Z
dc.date.available2022-08-23T15:43:56Z
dc.date.issued2009-01-26
dc.date.submitted2011-09-23
dc.identifier.citationJACC Cardiovasc Interv. 2009 Jan;2(1):26-33. <a href="http://dx.doi.org/10.1016/j.jcin.2008.09.010">Link to article on publisher's site</a>
dc.identifier.issn1876-7605 (Electronic)
dc.identifier.doi10.1016/j.jcin.2008.09.010
dc.identifier.pmid19463394
dc.identifier.urihttp://hdl.handle.net/20.500.14038/27205
dc.description.abstractOBJECTIVES: We investigated the relative benefit of reperfusion strategies in renal dysfunction and ST-segment elevation/left bundle branch block (STE/LBBB). BACKGROUND: Few data are available informing the treatment of STE myocardial infarction in the presence of renal dysfunction. METHODS: Patients (N = 12,532) from the GRACE (Global Registry of Acute Coronary Events) presenting with STE/LBBB were stratified by renal function and receipt of fibrinolysis, primary percutaneous coronary intervention (PCI), or neither. RESULTS: As renal function declined, hospital mortality increased and reperfusion decreased (both p < 0.001). Compared with no reperfusion, primary PCI was associated with lower hospital mortality in patients with normal renal function (1.9% vs. 3.7%, p = 0.001, adjusted) but no reduction in those with renal dysfunction (14% vs. 15% for glomerular filtration rate [GFR] 30 to 59 ml/min/1.73 m(2); 29% vs. 32% for GFR <30 ml/min/1.73 m(2)). Fibrinolysis was not associated with lower hospital mortality for normal (3.1% vs. 3.7%, p = NS) or low renal function (32% vs. 32%, p = NS) and with higher mortality with moderate renal dysfunction (adjusted odds ratio: 1.35, 95% confidence interval: 1.01 to 1.80). Primary PCI was associated with increased hospital bleeding and fibrinolysis with increased stroke in all patients. Among hospital survivors, primary PCI, but not fibrinolysis, was associated with lower mortality for moderate dysfunction. Both reperfusion strategies were associated with higher mortality for severe dysfunction. CONCLUSIONS: In STE/LBBB and renal dysfunction, mortality rates are high and reperfusion rates are lower. In moderate renal dysfunction, primary PCI is associated with mortality reduction at 6 months. Outcomes remain poor with severe renal dysfunction, despite receipt of reperfusion therapy.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=19463394&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1016/j.jcin.2008.09.010
dc.subjectAcute Coronary Syndrome
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectAngioplasty, Balloon, Coronary
dc.subject*Bundle-Branch Block
dc.subjectConfidence Intervals
dc.subjectFemale
dc.subjectFibrinolytic Agents
dc.subjectGlomerular Filtration Rate
dc.subjectHospital Mortality
dc.subjectHumans
dc.subjectIncidence
dc.subjectKidney Failure, Chronic
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectMyocardial Infarction
dc.subject*Myocardial Reperfusion
dc.subjectOdds Ratio
dc.subjectProspective Studies
dc.subjectRegistries
dc.subjectRisk Reduction Behavior
dc.subjectTreatment Outcome
dc.subjectHealth Services Research
dc.titleReperfusion in patients with renal dysfunction after presentation with ST-segment elevation or left bundle branch block: GRACE (Global Registry of Acute Coronary Events)
dc.typeJournal Article
dc.source.journaltitleJACC. Cardiovascular interventions
dc.source.volume2
dc.source.issue1
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/cor_grace/22
dc.identifier.contextkey2254941
html.description.abstract<p>OBJECTIVES: We investigated the relative benefit of reperfusion strategies in renal dysfunction and ST-segment elevation/left bundle branch block (STE/LBBB).</p> <p>BACKGROUND: Few data are available informing the treatment of STE myocardial infarction in the presence of renal dysfunction.</p> <p>METHODS: Patients (N = 12,532) from the GRACE (Global Registry of Acute Coronary Events) presenting with STE/LBBB were stratified by renal function and receipt of fibrinolysis, primary percutaneous coronary intervention (PCI), or neither.</p> <p>RESULTS: As renal function declined, hospital mortality increased and reperfusion decreased (both p < 0.001). Compared with no reperfusion, primary PCI was associated with lower hospital mortality in patients with normal renal function (1.9% vs. 3.7%, p = 0.001, adjusted) but no reduction in those with renal dysfunction (14% vs. 15% for glomerular filtration rate [GFR] 30 to 59 ml/min/1.73 m(2); 29% vs. 32% for GFR <30 ml/min/1.73 m(2)). Fibrinolysis was not associated with lower hospital mortality for normal (3.1% vs. 3.7%, p = NS) or low renal function (32% vs. 32%, p = NS) and with higher mortality with moderate renal dysfunction (adjusted odds ratio: 1.35, 95% confidence interval: 1.01 to 1.80). Primary PCI was associated with increased hospital bleeding and fibrinolysis with increased stroke in all patients. Among hospital survivors, primary PCI, but not fibrinolysis, was associated with lower mortality for moderate dysfunction. Both reperfusion strategies were associated with higher mortality for severe dysfunction.</p> <p>CONCLUSIONS: In STE/LBBB and renal dysfunction, mortality rates are high and reperfusion rates are lower. In moderate renal dysfunction, primary PCI is associated with mortality reduction at 6 months. Outcomes remain poor with severe renal dysfunction, despite receipt of reperfusion therapy.</p>
dc.identifier.submissionpathcor_grace/22
dc.contributor.departmentCenter for Outcomes Research
dc.source.pages26-33


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