Management Considerations for Acute Coronary Syndromes in Chronic Kidney Disease.

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Cardiology Reports Pub Date : 2024-05-01 Epub Date: 2024-03-07 DOI:10.1007/s11886-024-02039-0

Matthew I Tomey, Janice Y Chyou

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Abstract

Purpose of review: Propensity of patients with chronic kidney disease (CKD) to adverse outcomes of acute coronary syndromes (ACS) derives, in part, from imperfection in management. Dearth of data resulting from underrepresentation of patients with CKD in ACS trials and underuse of evidence-based testing and therapy compound biological risks inherent to CKD. We sought in this narrative review to critically appraise contemporary evidence and offer suggested approaches to practicing clinicians for the optimization of ACS management in patients with CKD.

Recent findings: Updated multisociety chest pain guidelines emphasize the diversity of clinical presentations of ACS, pertinent to recognition of ACS in patients with CKD. Evolving tools to predict and prevent acute kidney injury complicating invasive management of ACS serve to support improved access to and safety of percutaneous coronary intervention (PCI) in CKD patients, who remain at elevated risk. Growth in use of radial access, advances in PCI quality, incorporation of intravascular imaging, and new options and insights in pharmacotherapy contribute to an evolving calculus of ischemic and bleeding risk in ACS with bearing on management in CKD patients. Key opportunities to improve outcomes of ACS for patients with CKD center on avoiding underuse of beneficial medical and invasive therapies; enhancing safety of therapies by leveraging evidence-based strategies to prevent acute kidney injury; and devoting specific effort to investigation of ACS management in the context of CKD.

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慢性肾脏病急性冠状动脉综合征的管理注意事项。

综述目的：慢性肾脏病（CKD）患者易发生急性冠状动脉综合征（ACS）的不良后果，部分原因是管理不完善。由于 CKD 患者在 ACS 试验中代表性不足而导致的数据匮乏，以及对循证检测和治疗的使用不足，加剧了 CKD 固有的生物风险。在这篇叙述性综述中，我们试图对当代证据进行批判性评估，并为临床医生提供优化 CKD 患者 ACS 管理的建议方法：最新的多协会胸痛指南强调了急性冠状动脉综合征临床表现的多样性，这与识别慢性肾脏病患者的急性冠状动脉综合征有关。预测和预防急性肾损伤并发急性心肌梗死（ACS）侵入性治疗的工具不断发展，有助于提高 CKD 患者经皮冠状动脉介入治疗（PCI）的可及性和安全性，因为这些患者的风险仍然很高。径向入路使用的增加、PCI 质量的提高、血管内成像的采用以及药物治疗的新选择和新见解，都有助于不断发展的 ACS 缺血和出血风险计算，对 CKD 患者的管理也有影响。改善 CKD 患者 ACS 治疗效果的关键在于避免未充分利用有益的医疗和侵入性疗法；利用循证策略预防急性肾损伤，从而提高疗法的安全性；以及在 CKD 的背景下对 ACS 管理进行专门研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Cardiology Reports CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

6.20

自引率

2.70%

发文量

209

期刊介绍： The aim of this journal is to provide timely perspectives from experts on current advances in cardiovascular medicine. We also seek to provide reviews that highlight the most important recently published papers selected from the wealth of available cardiovascular literature. We accomplish this aim by appointing key authorities in major subject areas across the discipline. Section editors select topics to be reviewed by leading experts who emphasize recent developments and highlight important papers published over the past year. An Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research. We also provide commentaries from well-known figures in the field.