Title | Chronic kidney disease and the outcomes of fibrinolysis for ST-segment elevation myocardial infarction: A real-world study |
Authors | Xie, Wuxiang Patel, Anushka Boersma, Eric Feng, Lin Li, Min Gao, Runlin Wu, Yangfeng |
Affiliation | Peking Univ, Clin Res Inst, Hosp 1, Beijing, Peoples R China Univ New South Wales, George Inst Global Hlth, Sydney, NSW, Australia Erasmus Med Coll, Dept Cardiol, Rotterdam, Netherlands Peking Univ, Hlth Sci Ctr, George Inst Global Hlth, Beijing, Peoples R China Capital Med Univ, Beijing Friendship Hosp, Clin Epidemiol & EBM Ctr, Beijing, Peoples R China Chinese Acad Med Sci, Fuwai Hosp, Dept Cardiol, Beijing, Peoples R China Peking Union Med Coll, Beijing, Peoples R China Peking Univ, Sch Publ Hlth, Dept Epidemiol & Biostat, Hlth Sci Ctr, Beijing, Peoples R China |
Keywords | CARDIOVASCULAR EVENTS SERUM CREATININE RENAL-DISEASE ASSOCIATION MORTALITY TRIALS RISK |
Issue Date | 19-Jan-2021 |
Publisher | PLOS ONE |
Abstract | Background In low-resource regions, fibrinolytic therapy is often the only option for ST-elevation myocardial infarction (STEMI) patients as primary percutaneous coronary intervention (PCI) is often not available and patients are hardly transferred to a medical center with PCI capacity within the first 120 minutes. Chronic kidney disease (CKD) is one of the most frequently encountered complications of STEMI. However, the evidence for the efficacy of fibrinolytic therapy in STEMI patients with CKD is still limited. The aim of this study is to test whether CKD modifies the association between fibrinolytic therapy and short-term major adverse cardiovascular events (MACEs) among patients with STEMI. Methods and findings This is a real-world study analyzing the data from 9508 STEMI patients (mean age: 64.0 +/- 12.4 years; male: 70.1%) in the third phase of Clinical Pathways in Acute Coronary Syndromes program (CPACS-3), which is a large study of the management of acute coronary syndromes (ACS) in 101 county hospitals without PCI capacity in China. CKD was defined as an estimated glomerular filtration rate of less than 60 mL/min per 1.73 m(2) at the admission. The primary outcome is short-term MACEs, including all-cause death, recurrent myocardial infarction, or nonfatal stroke. Patients were recruited consecutively between October 2011 and November 2014. Out of them, 1282 patients (13.5%) were classified as having CKD. Compared with non-CKD patients, CKD patients were less likely to receive fibrinolytic therapy than non-CKD patients (26.4% vs. 38.9%, P<0.001), more likely to experience a failed fibrinolytic therapy (32.8% vs. 16.9%), and had a higher risk of short-term MACEs (19.7% vs. 5.6%). After full adjustment, use of fibrinolytic therapy was associated with a significantly lower risk of short-term MACEs in non-CKD patients (relative risk [RR] = 0.87, 95% confidence interval [CI]: 0.76-0.99), but not in CKD patients (P for interaction = 0.026). Further analysis stratified by the success of fibrinolysis showed that compared with patients who did not receive fibrinolytic therapy, patients with successful fibrinolysis had a lower risk of short-term MACEs that was similar between patients with (RR = 0.71, 95% CI: 0.55-0.82) and without CKD (RR = 0.67, 95% CI: 0.55-0.92), while patients with unsuccessful fibrinolysis had a similarly higher risk in CKD patients (RR = 1.25, 95% CI: 1.09-1.43) and non-CKD patients (RR = 1.30, 95% CI: 1.13-1.50). Conclusions CKD reduced the likelihood of successful fibrinolysis and increased the risk of short-term MACEs in patients with STEMI. Attention should be paid to how to improve the success rate of fibrinolytic therapy for STEMI patients with CKD. |
URI | http://hdl.handle.net/20.500.11897/604377 |
ISSN | 1932-6203 |
DOI | 10.1371/journal.pone.0245576 |
Indexed | SCI(E) |
Appears in Collections: | 公共卫生学院 |