The following is a summary of “Outcomes of Non–ST-Segment Myocardial Infarction During Chronic Heart Failure and End-Stage Renal Disease,” published in the August 2023 issue of the Cardiovascular Disease by Alhuarrat et al.

Non-ST-segment myocardial infarction (NSTEMI) commonly presents in an expanding demographic of individuals with chronic heart failure (HF) and end-stage renal disease (ESRD); however, the effectiveness of invasive management strategies in these cases remains uncertain. Researcher’s objective was to assess the in-hospital outcomes of percutaneous coronary intervention (PCI) compared to exclusive medical management. The National Inpatient Sample was used to document United States hospital admissions from 2006 to 2019. Admissions for non-ST elevation myocardial infarction (NSTEMI) in patients with chronic heart failure (HF) and end-stage renal disease (ESRD) were identified using International Classification of Diseases (ICD) codes. 

The cohort was divided into individuals who underwent percutaneous coronary intervention (PCI) or received medical management exclusively. In-patient outcomes were assessed using multivariable logistic regression and propensity-matching techniques. Out of a total of 27,433 hospitalizations, 8,004 patients (29%) received percutaneous coronary intervention (PCI), while 19,429 (71%) were managed solely through pharmacological interventions. Percutaneous coronary intervention (PCI) was found to be correlated with decreased adjusted likelihood of mortality during hospitalization (adjusted odds ratio 0.59, 95% confidence interval 0.52 to 0.66, P<0.01). This correlation remained stable following propensity matching (adjusted odds ratio 0.56, 95% CI 0.49 to 0.64, P <0.01) and was evident in all subcategories of heart failure. 

Patients with percutaneous coronary intervention exhibited a significantly longer duration of hospitalization (5, 3 to 9 days vs. 5, 3 to 8 days, P <0.01) and higher cost of hospitalization ($107,942, 70,230 to $173,182 vs. $44,156, 24,409 to $80,810, P <0.01). In summary, individuals with heart failure and end-stage renal disease who were hospitalized for non-ST segment elevation myocardial infarction demonstrated reduced rates of mortality during their hospital stay when treated with percutaneous coronary intervention instead of solely receiving medical therapy. Invasive percutaneous revascularization may be viable for appropriately selected patients with heart failure and end-stage renal disease (ESRD). However, it is crucial to conduct randomized controlled trials to ascertain the safety and effectiveness of this procedure in this particular population, which is at high risk.

Source: sciencedirect.com/science/article/abs/pii/S0002914923002837