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Estrategia invasiva de rutina en el síndrome coronario agudo sin elevación del segmento ST con disfunción renal. Resultados del registro ARIAM-SEMICYUC
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Title: Estrategia invasiva de rutina en el síndrome coronario agudo sin elevación del segmento ST con disfunción renal. Resultados del registro ARIAM-SEMICYUC |
Authors: Latour-Perez, Jaime Gómez-Tello, V. Llamas-Álvarez, A. Carrillo-López, A. Sánchez-Román, J.A. Ruíz-Ruíz, J. Martín-Rodríguez, M.C. Fernández-González, C.J. Fernández-Lozano, J.A. Picazos Vicente, C. Grupo ARIAM-SEMICYUC |
Editor: Elsevier |
Department: Departamentos de la UMH::Medicina Clínica |
Issue Date: 2016 |
URI: https://hdl.handle.net/11000/31283 |
Abstract:
Objetivo: Evaluar la utilización y efectividad de la estrategia invasiva de rutina (EIR) en pacientes con síndrome coronario agudo sin elevación de ST con disfunción renal en el mundo real. Métodos: Estudio de cohortes retrospectivo basado en el registro ARIAM-SEMICYUC (años 2011- 2014). Se conside... Ver más
Objective: To evaluate the use and effectiveness of a routine invasive strategy (RIS) in patients with acute coronary syndrome without persistent ST-segment elevation with renal dysfunction in the real world scenario. Methods: A retrospective cohort study based on the ARIAM-SEMICYUC Registry (2011-2014) was carried out. Renal dysfunction was defined as GFR (Cockroft-Gault)<60ml/min (moderate dysfunction) or<30ml/min (severe dysfunction). Patients in which early angiography (<72h) was performed due to cardiogenic shock or recurrent myocardial ischemia were excluded. The primary endpoint was hospital mortality. Confounding factors were controlled using propensity score analysis. Results: A total of 4,279 patients were analyzed, of which 26% had moderate renal dysfunction and 5% severe dysfunction. Patients with renal dysfunction had greater severity and comorbidity, higher hospital mortality (8.6 vs. 1.8%), and lesser use of the RIS (40 vs. 52%). The adjusted OR for mortality in patients without/with renal dysfunction were 0.38 (95% confidence interval [95%CI] 0.17 to 0.81) and 0.52 (95%CI 0.32 to 0.87), respectively (interaction P-value=.4779). The impact (adjusted risk difference) of RIS was higher in the group with renal dysfunction (-5.1%, 95%CI -8.1 to -2.1 vs. -1.6%, 95%CI -2.6 to -0.6; interaction P-value=.0335). No significant interaction was detected for the other endpoints considered (ICU mortality, 30-day mortality, myocardial infarction, acute renal failure or moderate/severe bleeding).Conclusions: The results suggest that the effectiveness of IRS is similar in patients with normal or abnormal renal function, and alert to the under-utilization of this strategy in such patients.
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Keywords/Subjects: Intervención coronaria percutánea Síndrome coronario agudo Disfunción renal Mortalidad Registros Percutaneous coronary intervention Acute coronary syndrome Renal dysfunction Mortality Registries |
Type of document: info:eu-repo/semantics/article |
Access rights: info:eu-repo/semantics/closedAccess Attribution-NonCommercial-NoDerivatives 4.0 Internacional |
DOI: 10.1016/j.medin.2015.09.008. |
Appears in Collections: Artículos Medicina Clínica
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