Large Study From Nationwide Database Suggests Invasive Therapy Is Safe and Effective to Treat NSTEMI in Patients With CKD

June 21, 2022—Indiana University (IU) School of Medicine in Indianapolis, Indiana, announced the publication of an observational study of 141,000 patients that suggests physicians should consider an early invasive strategy in treating patients with chronic kidney disease (CKD) who are experiencing a non–ST-segment elevation myocardial infarction (NSTEMI). The study was drawn from a nationwide readmission database. The investigators found that there was no strong association between invasive therapy and acute kidney injury, and that these patients treated with this approach had lower mortality, lower risk of cardiac and cerebrovascular adverse events, and lower need for revascularization through stenting or surgery.

The study was led by Ankur Kalra, MD, who is Associate Professor of Clinical Medicine at the IU School of Medicine Department of Medicine and Medical Director of Interventional Cardiology Quality and Innovation at IU’s Cardiovascular Institute. Monil Majmundar, MD, et al published the findings online in Journal of the American Heart Association.

According to IU School of Medicine, an early invasive strategy has long been thought to be too risky for patients with CKD. Additionally, patients with CKD have historically been excluded from randomized clinical trials exploring the more invasive strategy, leading to a lack of data on the best way to treat NSTEMIs in this population.

“These findings are important because they show that the benefits of offering invasive therapy to these patients upfront outweigh the risks,” commented Dr. Kalra in the IU School of Medicine announcement. “This study will influence decision-making by physicians and the development of treatment guidelines for NSTEMI in this population of patients.”

Dr. Kalra said that many physicians have been reluctant to pursue an invasive strategy—diagnostic angiogram followed by revascularization through stenting or open heart surgery—for patients with CKD because of a perception of increased risk for adverse events, such as bleeding or acute kidney injury caused by the dye used during an angiogram. In deference to these concerns, patients with CKD are instead usually treated with medical management of a dye-free echocardiogram and a prescription for aspirin, statin, and β-blockers.

In the IU press release, Dr. Kalra stated that the study suggests medical management may be too conservative, and CKD patients are being disadvantaged by not being offered the more aggressive strategy. He concluded, “This is a challenging population to treat, and individualized care is important. But our results suggest that invasive therapy should be offered to all patients in this category.”