title: Association of glomerular filtration rate on presentation with subsequent mortality in non-ST-segment elevation acute coronary syndrome; observations in 13,307 patients in five TIMI trials.
abstract: OBJECTIVE
  To determine the association of glomerular filtration rate (GFR) with clinical outcomes in the setting of non-ST-segment elevation acute coronary syndromes (NSTE-ACS).
  
  
  RESULTS
  Data were pooled from five NSTE-ACS TIMI trials (TIMI 11A and B, TIMI 12, OPUS-TIMI 16 and TACTICS-TIMI 18) and were available in 13 307 patients. GFR was assessed as a continuous and a categorical variable (normal: > or = 90 mL/min/1.73 m2, n=4952; mildly decreased: 60-89 mL/min/1.73 m2, n=6262; and moderately to severely decreased GFR: <60 mL/min/1.73 m2, n=2093). There was an independent association between decreasing GFR and mortality at 30 days (OR 1.19, 95% CI 1.12-1.27, p<0.001) and at 6 months (OR 1.16, 95% CI 1.11-1.22, p<0.001). The combination of TIMI risk score (TRS) and decreasing GFR provided further mortality risk stratification with highest 30-day and 6-month mortality rates among patients with the lowest GFR who also had a TRS > or = 5 (9.1% and 15.4%, respectively). Decreasing GFR was also independently associated with stroke and recurrent ischaemia at 30-days as well as with major bleeding (p<0.001).
  
  
  CONCLUSIONS
  In the setting of NSTE-ACS, impaired GFR is associated with higher mortality as well as higher rates of thrombotic and major bleeding events, independent of TRS.
authors.affiliation: Cardiovascular Division, Brigham & Women's Hospital and the Department of Medicine, Harvard Medical School, 350 Longwood Avenue, Boston, MA 02115, USA. mgibson@timi.org
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
authors.forename: Raphaelle L
authors.initials: RL
authors.lastname: Dumaine
authors.forename: Eli V
authors.initials: EV
authors.lastname: Gelfand
authors.forename: Sabina A
authors.initials: SA
authors.lastname: Murphy
authors.forename: David A
authors.initials: DA
authors.lastname: Morrow
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Wiviott
authors.forename: Robert P
authors.initials: RP
authors.lastname: Giugliano
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.forename: Elliott M
authors.initials: EM
authors.lastname: Antman
authors.forename: Eugene
authors.initials: E
authors.lastname: Braunwald
mesh_terms: D003327:Coronary Disease / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000401:mortality; D007674:Kidney Diseases / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors