Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

VA Health Systems Research

Go to the VA ORD website
Go to the QUERI website

HSR&D Citation Abstract

Search | Search by Center | Search by Source | Keywords in Title

Patients with severe chronic kidney disease benefit from early revascularization after acute coronary syndrome.

Huang HD, Alam M, Hamzeh I, Virani S, Deswal A, Aguilar D, Rogers P, Kougias P, Birnbaum Y, Paniagua D, Kar B, Ballantyne C, Bozkurt B, Jneid H. Patients with severe chronic kidney disease benefit from early revascularization after acute coronary syndrome. International Journal of Cardiology. 2013 Oct 9; 168(4):3741-6.

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

If you have VA-Intranet access, click here for more information

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.
   Search Dimensions for VA for this citation
* Don't have VA-internal network access or a VA email address? Try searching the free-to-the-public version of Dimensions


BACKGROUND: Early revascularization is associated with improved outcomes after non-ST-elevation acute coronary syndrome (ACS). It is unclear whether its benefits exist in patients with ACS and advanced chronic kidney disease (CKD), because these patients are often sub-optimally treated and excluded from clinical trials. METHODS: We undertook meta-analyses of short- and long-term mortality outcomes in comparative studies examining the effectiveness of early revascularization in patients with ACS and CKD (as estimated by Glomerular Filtration Rate, eGFR). A literature search between 1995 and 2010 identified 7 published reports enrolling 23,234 patients with at least mild reduction in eGFR ( < 90 mL/min/1.73 m(2)), of whom 6276 and 16,958 patients received early revascularization versus initial medical therapy, respectively. Summary odds ratios (OR) and their 95% Confidence Intervals (CIs) were calculated using the random-effects models. Sensitivity analyses were performed by one-study removal, and publication bias was assessed by the funnel plot analysis. RESULTS: Early revascularization was associated with a reduction in 1-year mortality compared to initial medical therapy (OR = 0.46, 95% CI 0.26-0.82, P = 0.008) among ACS patients with eGFR < 60 mL/min/1.73 m(2). The mortality reduction with early revascularization occurred upfront (short term mortality OR = 0.69, 95% CI 0.56-0.87, P = 0.001), persisted at 3 years (OR = 0.54, 95% CI 0.31-0.96, P = 0.037), was evident across all CKD stages (including dialysis patients), and was independent of the influence of any single study. CONCLUSIONS: Early revascularization after ACS is associated with reduced mortality in appropriately-selected patients with CKD, including those with severe CKD or receiving dialysis.

Questions about the HSR website? Email the Web Team

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.