SANTOS, M. Teresa et al. Chronic kidney disease in patients with acute myocardial infarction without ST segment elevation: therapeutic nihilism?. []. , 28, 1, pp.55-60. ISSN 0872-0169.

^len^aBackground: Chronic kidney disease is an independent risk factor for mortality after acute coronary syndrome. Our aim was to characterize the in-hospital management and outcomes of patients with chronic kidney disease in the setting of non-ST-segment elevation myocardial infarction. Methods: This is a single centre, prospective and observational study, including 230 consecutive patients admitted with the diagnosis of non-ST-segment elevation myocardial infarction. Glomerular filtration rate was estimated using the Modification of Diet in Renal Disease Study formula and in-hospital therapies and outcomes were recorded. Results: Overall, 25.7% of patients had moderate to severe chronic kidney disease. Patients with chronic kidney disease were less likely to undergo coronary angiography (27% vs. 81%, p < 0.001) and receive less evidence-based therapies, including aspirin (86.4% vs. 98.8%, p < 0.001), clopidogrel (74.6% vs. 90.6%, p = 0.002), angiotensin-converting enzyme inhibitor and/or angiotensin II receptor blocker (54.2% vs. 90.6%, p < 0.001) or anticoagulant therapy (83.1% vs. 95.9%, p = 0.001). In addition, the in-hospital mortality was higher for patients with chronic kidney disease (15.3% vs. 2.9%; p = 0.002). Conclusion: Non-ST-segment elevation myocardial infarction patients with chronic kidney disease have higher in-hospital mortality. The underuse of evidence-based therapies and interventions can help to explain these results.^lpt^aIntrodução: A doença renal crónica é um fator de risco independente para mortalidade após síndrome coronário agudo. O objetivo deste estudo foi caracterizar o tratamento, complicações e mortalidade intrahospitalar dos doentes com doença renal crónica internados no contexto de enfarte agudo do miocárdio sem elevação do segmento ST. Métodos: Estudo unicêntrico, observacional e prospetivo que incluiu 230 doentes internados com o diagnóstico de enfarte agudo do miocárdio sem elevação do segmento ST. A taxa de filtração glomerular foi estimada pela fórmula Modification of Diet in Renal Disease Study e foi avaliado o tratamento, complicações e mortalidade intra-hospitalar. Resultados : Do total de doentes admitidos no estudo, 25.7% apresentavam doença renal crónica moderada a grave. Os doentes com doença renal crónica foram menos submetidos a cateterismo cardíaco (27% vs. 81%, p< 0.001) e foram menos medicados com terapêutica baseada na evidência, nomeadamente aspirina (86.4% vs. 98.8%, p < 0.001), clopidogrel (74.6% vs. 90.6%, p = 0.002), inibidor da enzima de conversão da angiotensina e/ou antagonista do receptor da angiotensina II (54.2% vs. 90.6%, p < 0.001) e anticoagulantes (83.1% vs. 95.9%, p = 0.001). Os doentes com doença renal crónica apresentaram mortalidade intra-hospitalar superior (15.3% vs. 2.9%; p = 0.002). Conclusão: Neste estudo os doentes com enfarte agudo do miocárdio sem elevação do segmento ST e doença renal crónica apresentam mortalidade intra-hospitalar superior. A subutilização de terapêutica baseada na evidência poderá ajudar a explicar estes resultados.

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