{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T23:36:15Z","timestamp":1787960175303,"version":"build-2784847793"},"reference-count":30,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2014,1,30]],"date-time":"2014-01-30T00:00:00Z","timestamp":1391040000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100005564","name":"Gilead","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100005564","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2014,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Chronic kidney disease (<jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>) is associated with an increased risk of cardiovascular events following acute coronary syndrome (<jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content>). The underlying pathobiology and optimal treatments for this population continue to be evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Hypothesis<\/jats:title><jats:p>Patients with <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content> will receive fewer evidence\u2010based therapies and experience high rates of adverse cardiovascular events in both the short\u2010 and long term.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The <jats:styled-content style=\"fixed-case\">MERLIN\u2010TIMI<\/jats:styled-content> 36 (Metabolic Efficiency With Ranolazine for Less Ischemia in Non\u2013<jats:styled-content style=\"fixed-case\">ST<\/jats:styled-content>\u2010Elevation Acute Coronary Syndromes\u2010Thrombolysis in Myocardial Infarction 36) trial randomized non\u2013<jats:styled-content style=\"fixed-case\">ST<\/jats:styled-content>\u2010elevation <jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content> patients to ranolazine or placebo, with no exclusion for renal dysfunction (except dialysis). We conducted a prespecified analysis among 6543 patients based on the degree of <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients with worse renal function were older with more comorbidities (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001 for each). They were less likely to receive evidence\u2010based cardiovascular medicines (<jats:italic>P<\/jats:italic> &lt; 0.04 for each). Rates of an early invasive management strategy varied based on renal function; however, among patients with the highest <jats:styled-content style=\"fixed-case\">TIMI<\/jats:styled-content> risk scores, the rates of an early invasive management strategy were similar regardless of glomerular filtration rate (<jats:styled-content style=\"fixed-case\">GFR<\/jats:styled-content>) (<jats:italic>P<\/jats:italic><jats:sub>interaction<\/jats:sub>\u2009=\u20090.005). Lower <jats:styled-content style=\"fixed-case\">GFR<\/jats:styled-content> was associated with increased rates of cardiovascular disease or myocardial infarction in the short and long term, even after adjustment (<jats:styled-content style=\"fixed-case\">GFR<\/jats:styled-content> &lt;30 vs \u226590 <jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content>\/min\/1.73 m<jats:sup>2<\/jats:sup>; hazard ratio [<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>]: 3.24 [95% confidence interval {<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>}: 1.26\u20108.38] through 7 days and <jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>: 2.12 [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 1.33\u20103.39] through 1 year). The effect of ranolazine vs placebo on clinical outcomes was similar among those with and without <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content> (<jats:italic>P<\/jats:italic><jats:sub>interaction<\/jats:sub>\u2009=\u2009not significant).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Following <jats:styled-content style=\"fixed-case\">ACS<\/jats:styled-content>, patients with renal dysfunction had more cardiovascular risk factors but were less likely to receive evidence\u2010based medical therapies. A strong graded, independent relationship between the degree of <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content> and poor clinical outcomes was observed over time. Continued efforts to optimize ACS treatment strategies in patients with CKD are warranted.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.22253","type":"journal-article","created":{"date-parts":[[2014,1,30]],"date-time":"2014-01-30T20:42:04Z","timestamp":1391114524000},"page":"350-356","source":"Crossref","is-referenced-by-count":17,"title":["Clinical Features, Use of Evidence\u2010Based Therapies, and Cardiovascular Outcomes Among Patients With Chronic Kidney Disease Following Non\u2013<scp>ST<\/scp>\u2010Elevation Acute Coronary Syndrome"],"prefix":"10.1002","volume":"37","author":[{"given":"June\u2010Wha","family":"Rhee","sequence":"first","affiliation":[{"name":"Department of Medicine Stanford University Medical Center  Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen D.","family":"Wiviott","sequence":"additional","affiliation":[{"name":"TIMI Study Group, Cardiovascular Division, Department of Medicine Brigham and Women's Hospital Harvard Medical School  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin M.","family":"Scirica","sequence":"additional","affiliation":[{"name":"TIMI Study Group, Cardiovascular Division, Department of Medicine Brigham and Women's Hospital Harvard Medical School  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. 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