Early Invasive Strategy and Outcome of Non–ST-Segment Elevation Myocardial Infarction Patients With Chronic Kidney Disease

Amir Sharon, Eias Massalha, Boris Fishman, Paul Fefer, Israel M. Barbash, Amit Segev, Shlomi Matetzky, Victor Guetta, Ehud Grossman, Elad Maor*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Current guidelines suggest that an early invasive strategy should be considered for the treatment of non–ST-segment elevation myocardial infarction (NSTEMI). Although chronic kidney disease (CKD) is common among NSTEMI patients, these patients are under-represented in clinical trials, and data regarding their management are limited. Objectives: The authors sought to evaluate the association between early invasive strategy and long-term survival among patients with NSTEMI and CKD. Methods: This was a retrospective analysis of 7,107 consecutive NSTEMI patients between 2008 and 2021. Patients were dichotomized into early (≤24 hours) and delayed invasive groups and stratified by kidney function. Inverse probability treatment weighting was used to adjust for differences in baseline characteristics. The primary outcome was all-cause mortality. Results: The final study population comprised 3,529 invasively treated patients with a median age of 66 years (IQR: 58-74 years), 1,837 (52%) of whom were treated early. There were 483 (14%) patients with at least moderate CKD (estimated glomerular filtration rate [eGFR] <45 mL/min/1.73 m2). During a median follow-up of 4 years (IQR: 2-6 years), 527 (15%) patients died. After inverse probability treatment weighting, an early invasive strategy was associated with a significant 30% lower mortality compared with a delayed strategy (HR: 0.7; 95% CI: 0.56-0.85). The association between early invasive strategy and mortality was modified by eGFR (Pinteraction < 0.001) and declined with lower renal function, with no difference in mortality among patients with eGFR <45 mL/min/1.73 m2 (HR: 0.89; 95% CI: 0.64-1.24). Conclusions: Among NSTEMI patients, the association of early invasive strategy with long-term survival is modified by CKD and was not observed in patients with eGFR <45 mL/min/1.73 m2.

Original languageEnglish
Pages (from-to)1977-1988
Number of pages12
JournalJACC: Cardiovascular Interventions
Issue number19
StatePublished - 10 Oct 2022


  • invasive strategy
  • kidney disease
  • myocardial infarction
  • prognosis


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