Observational studyBMJ open2025
Guideline-directed medical therapy and in-hospital mortality in acute coronary syndrome patients with advanced renal dysfunction: analysis of two nationwide retrospective cohort studies.
Observational study in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
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Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThe purpose of this study was to verify whether guideline-directed medical therapy (GDMT, ie, the combined use of β-blocker, ACE inhibitor/angiotensin receptor blocker, dual antiplatelet drugs and statin) could improve in-hospital mortality in acute coronary syndrome (ACS) patients with advanced renal dysfunction (estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m
designRetrospective cohort study.
settingThis study used data from two large, multicentre, observational cohorts: the Chinese National Electronic Disease Surveillance System Platform (CNEDSSP) and the Improving Care for Cardiovascular Disease in China-ACS (CCC-ACS) project. These cohorts consist of ACS patients admitted to 47 and 241 hospitals, respectively, across China from 2014 to 2019.
participantsA total of 6260 patients diagnosed with advanced renal dysfunction (eGFR <30 mL/min/1.73 m²) on admission were included in the analysis. Among these, 3013 patients were from the CNEDSSP cohort and 3247 from the CCC-ACS cohort. Patients were categorised based on receipt of GDMT within 24 hours of admission. MAIN EXPOSURE MEASURE: The main exposure measure was the early use of GDMT, defined as the administration of all four components of GDMT within 24 hours of hospital admission.
main outcome measureThe primary outcome was in-hospital mortality, assessed within the study cohort.
resultsIn a pooled analysis of the CNEDSSP and CCC-ACS cohorts, early GDMT was associated with a significant reduction in in-hospital mortality (relative risk (RR): 0.62, 95% CI: 0.47 to 0.81). More pronounced reductions were observed in myocardial infarction (MI) patients, with HRs of 0.31 (95% CI: 0.17 to 0.55) in the CNEDSSP cohort and 0.47 (95% CI: 0.28 to 0.77) in the CCC-ACS cohort. A random-effects pooled analysis of MI patients with advanced renal dysfunction at admission showed a 61% reduction in in-hospital mortality among GDMT users (RR: 0.39, 95% CI: 0.27 to 0.58).
conclusionsThis nationwide study highlights that early GDMT is associated with a reduced risk of in-hospital mortality in ACS patients (particularly in MI patients) with advanced renal dysfunction.
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