• J Latour-Pérez, V Gómez-Tello, E de-Miguel-Balsa, A Llamas-Álvarez, A Carrillo-López, J A Sánchez-Román, J Ruíz-Ruíz, M C Martín-Rodríguez, C J Fernández-González, J A Fernández-Lozano, C Picazos Vicente, and Grupo ARIAM-SEMICYUC.
• Hospital General Universitario de Elche, Elche, Alicante, España. Electronic address: jlatour@coma.es.
• Med Intensiva. 2016 Jun 1; 40 (5): 280-8.

ObjectiveTo 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.MethodsA 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.ResultsA 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).ConclusionsThe 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.Copyright © 2015 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

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