The prognostic impact of in-hospital worsening of renal function in patients with acute coronary syndrome

• Published in: International journal of cardiology Vol. 167; no. 3; pp. 866 - 870
• Main Authors: AlFaleh, Hussam F, Alsuwaida, Abdulkareem O, Ullah, Anhar, Hersi, Ahmad, AlHabib, Khalid F, AlNemer, Khalid, AlSaif, Shukri, Taraben, Amir, Kashour, Tarek, Balghith, Mohammed A, Ahmed, Waqar H
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 10.08.2013; Elsevier
• Subjects: Acute coronary syndrome; Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - mortality; Acute Coronary Syndrome - physiopathology; Adult; Aged; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Cardiovascular outcomes; Coronary heart disease; Female; Heart; Hospital Mortality - trends; Hospitalization - trends; Humans; Kidney Failure, Chronic - physiopathology; Kidney Function Tests - trends; Male; Medical sciences; Middle Aged; Myocarditis. Cardiomyopathies; Prognosis; Prospective Studies; Registries; Saudi Arabia - epidemiology; Worsening renal function; Saudi Arabia; Cardiovascular outcomes; Acute coronary syndrome; Worsening renal function; Human; Kidney disease; Urinary system disease; Renal function; Prognosis; Patient; Cardiovascular disease; Hospitalization; Coronary heart disease; Myocardial disease; Hospital; Cardiology; Aggravation; Public health
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2012.01.097

Abstract Background Renal impairment is strongly linked to adverse cardiovascular (CV) events. Baseline renal dysfunction is a strong predictor of CV mortality and morbidity in patients admitted with acute coronary syndrome (ACS). However, the prognostic importance of worsening renal function (WRF) in these patients is not well characterized. Methods ACS patients enrolled in the SPACE (Saudi Project for Assessment of Coronary Events) registry who had baseline and pre-discharge serum creatinine data available were eligible for this study. WRF was defined as a 25% reduction from admission estimated glomerular filtration rate (eGFR) within 7 days of hospitalization. Baseline demographics, clinical presentation, therapies, and in-hospital outcomes were compared. Results Of the 3583 ACS patients, WRF occurred in 225 patients (6.3%), who were older, had more cardiovascular risk factors, were more likely to be female, have past vascular disease, and presented with more non-ST-segment elevation myocardial infarction than patients without WRF (39.5% vs. 32.8%; p = 0.042). WRF was associated with an increased risk of in-hospital death, heart failure, cardiogenic shock, and stroke. After adjusting for potential confounders, WRF was an independent predictor of in-hospital death (adjusted odd ratio 28.02, 95% CI 13.2–60.28, p < 0.0001). WRF was more predictive of mortality than baseline eGFR. Conclusion These results indicate that WRF is a powerful predictor for in-hospital mortality and CV complications in ACS patients.