Temporal management patterns and outcomes of non-ST elevation acute coronary syndromes in patients with kidney dysfunction

Aims To examine: (i) the temporal changes in the management pattern; (ii) the reasons for any treatment disparities; (iii) the relationship between invasive treatment and outcome, among acute coronary syndrome (ACS) patients with vs. without kidney dysfunction. Methods and results Canadian ACS I, ACS II registries and Global Registry of Acute Coronary Events (GRACE) were prospective, multi-centre, observational studies of patients with ACS. From 1999 to 2007, non-ST elevation (NSTE) ACS patients were recruited in ACS I (n = 3295; 1999–2001), ACS II (n = 1956; 2002–2003), and GRACE (n = 6491; 2004–2007) in Canada. Using the four-variable Modified Diet in Renal Disease equation, we stratified the study population (n = 11 377) into three groups based on their estimated glomerular filtration rate (eGFR), and examined their treatment and outcome. While in-hospital use of coronary angiography and revascularization increased over time in all groups (P < 0.001), patients with kidney dysfunction were less likely to undergo invasive management (P < 0.001). Unadjusted 1 year mortality was lower among patients receiving in-hospital coronary angiography within all eGFR categories (≥60 mL/min/1.73 m2: 2.5 vs. 7.6%, P < 0.001; 30–59 mL/min/1.73 m2: 8.0 vs. 14.6%, P < 0.001;