ArticleBMJ (Clinical research ed.)2013
Renal outcomes associated with invasive versus conservative management of acute coronary syndrome: propensity matched cohort study.
Article in BMJ (Clinical research ed.), 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 41 citations in OpenAlex.
- Pooled it
- Deescalation From Ticagrelor to Clopidogrel for Myocardial Infarction With Chronic Kidney Disease: A Secondary Analysis of a Randomized Clinical Trial.JAMA network open · 2025Trial
- Derivation and Validation of Risk Prediction Models for Cardiovascular and Kidney Outcomes of Non-ST-Segment-Elevation Acute Coronary Syndrome in Patients With Chronic Kidney Disease.Journal of the American Heart Association · 2026Article
- Human-Centred Design & Development of aCJC open · 2025Article
- Management Considerations for Acute Coronary Syndromes in Chronic Kidney Disease.Current cardiology reports · 2024Review
- Preferences of Patients With Chronic Kidney Disease for Invasive Versus Conservative Treatment of Acute Coronary Syndrome: A Discrete Choice Experiment.Journal of the American Heart Association · 2023Article
- Treatment Preferences for Cardiac Procedures of Patients With Chronic Kidney Disease in Acute Coronary Syndrome: Design and Pilot Testing of a Discrete Choice Experiment.Canadian journal of kidney health and disease · 2021Article
- Conventional Risk Factors Associated With Meaningful Outcomes in Advanced CKD.Kidney international reports · 2018Article
- Contrast-associated acute kidney injury is a myth: Yes.Intensive care medicine · 2018Article
- Kidney Function Does Not Modify the Favorable Quality of Life Changes Associated With Revascularization for Coronary Artery Disease: Cohort Study.Journal of the American Heart Association · 2016Article
- Article
- Acute coronary syndromes: management of acute coronary syndrome-renal outcomes.Nature reviews. Nephrology · 2013Article
- Article
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Authors and funding
10 authors at 3 institutions in 1 country.
Funding
Abstract
objectivesTo examine the association of early invasive management of acute coronary syndrome with adverse renal outcomes and survival, and to determine whether the risks or benefits of early invasive management differ in people with pre-existing chronic kidney disease.
designPropensity score matched cohort study.
settingAcute care hospitals in Alberta, Canada, 2004-09.
participants10,516 adults with non-ST elevation acute coronary syndrome.
interventionsParticipants were stratified by baseline estimated glomerular filtration rate and matched 1:1 on their propensity score for early invasive management (coronary catheterisation within two days of hospital admission).
main outcome measuresRisks of acute kidney injury, kidney injury requiring dialysis, progression to end stage renal disease, and all cause mortality were compared between those who received early invasive treatment versus conservative treatment.
resultsOf 10,516 included participants, 4276 (40.7%) received early invasive management. After using propensity score methods to assemble a matched cohort of conservative management participants with characteristics similar to those who received early invasive management (n=6768), early invasive management was associated with an increased risk of acute kidney injury (10.3% v 8.7%, risk ratio 1.18, 95% confidence interval 1.03 to 1.36; P=0.019), but no difference in the risk of acute kidney injury requiring dialysis (0.4% v 0.3%, 1.20, 0.52 to 2.78; P=0.670). Over a median follow-up of 2.5 years, the risk of progression to end stage renal disease did not differ between the groups (0.3 v 0.4 events per 100 person years, hazard ratio 0.91, 95% confidence interval 0.55 to 1.49; P=0.712); however, early invasive management was associated with reduced long term mortality (2.4 v 3.4 events per 100 person years, 0.69, 0.58 to 0.82; P<0.001). These associations were consistent among people with pre-existing reduced estimated glomerular filtration rate and with alternate definitions for early invasive management.
conclusionsCompared with conservative management, early invasive management of acute coronary syndrome is associated with a small increase in risk of acute kidney injury but not dialysis or long term progression to end stage renal disease.
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