Prognostic value of glomerular function estimated by Cockcroft-Gault creatinine clearance, MDRD-4, CKD-EPI and European Kidney Function Consortium equations in patients with acute coronary syndromes

• Published in: Clinica chimica acta Vol. 523; pp. 106 - 113
• Main Authors: Ndrepepa, Gjin, Holdenrieder, Stefan, Neumann, Franz-Josef, Lahu, Shqipdona, Cassese, Salvatore, Joner, Michael, Xhepa, Erion, Kufner, Sebastian, Wiebe, Jens, Laugwitz, Karl-Ludwig, Gewalt, Senta, Schunkert, Heribert, Kastrati, Adnan
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.12.2021
• Subjects: Acute coronary syndrome; Acute Coronary Syndrome - diagnosis; Bleeding; Creatinine; Estimated glomerular filtration rate; Glomerular Filtration Rate; Humans; Kidney; Mortality; Myocardial infarction; Prognosis; Renal Insufficiency, Chronic - diagnosis; Myocardial infarction; Acute coronary syndrome; Estimated glomerular filtration rate; Mortality; Bleeding
• ISSN: 0009-8981; 1873-3492
• DOI: 10.1016/j.cca.2021.09.007

•Cockcroft-Gault creatinine clearance and EKFC equations predict mortality better than MDRD-4 and CKD-EPI equations.•Cockcroft-Gault creatinine clearance and EKFC equations predict bleeding better than MDRD-4 and CKD-EPI equations.•All four eGFR equations failed to improve risk prediction for myocardial infarction. It remains unknown which equation used to assess the glomerular function is better for risk stratification in patients with acute coronary syndrome (ACS). This study included 3985 patients with ACS. Glomerular function was assessed using 4 equations: the Cockcroft-Gault creatinine clearance (C-GCrCl), Modification of Diet in Renal Disease-4 (MDRD-4), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and European Kidney Function Consortium (EKFC) equations. The primary outcome was one-year all-cause mortality. For each 30 ml/min decrement, the adjusted hazard ratio [HR] with 95% confidence interval [CI] for one-year mortality was 1.67 [1.27–2.25] for C-GCrCl, 1.45 [1.16–1.81] for MDRD-4, 1.76 [1.35–2.30] for CKD-EPI and 1.94 [1.44–2.63] for EKFC equation. Area under the receiver operating characteristic curve (AUC) for one-year mortality was 0.748 [0.709–0.788] for C-GCrCl, 0.670 [0.621–0.718] for estimated glomerular filtration rate (eGFR) calculated by MDRD-4 equation, 0.725 [0.684–0.765] for eGFR calculated by CKD-EPI equation and 0.741 [0.703–0.779] for eGFR calculated by EKFC equation (P = 0.342 for C-GCrCl, vs. EKFC equation and P ≤ 0.009 for all other AUC comparisons). In patients with ACS, C-GCrCl and EKFC equations showed a similar discriminatory power regarding prediction of one-year mortality. Both equations were better than MDRD-4 and CKD-EPI equations for risk discrimination for mortality. Clinical Trial Registration: NCT01944800.