[Prognostic value of serum creatinine in non-ST-elevation acute coronary syndrome].
OBJECTIVE
Cardiovascular disease is the main cause of death in patients with kidney failure. Moreover, the presence of impaired renal function is an important prognostic factor in patients with heart disease, and is a determinant of outcome during follow-up. The main aim was to investigate the relationship between kidney failure at admission and one-year mortality in patients with non-ST-elevation acute coronary syndrome.


METHODS
We studied 1029 consecutive patients admitted to our institution. The serum creatinine level and glomerular filtration rate were determined at admission, and classical risk factors and biochemical markers were assessed. The primary endpoint was all-cause mortality at one year.


RESULTS
Patients who died were older, more frequently had a history of diabetes or coronary artery disease, were more likely to have heart failure at admission, had higher troponin-I, myoglobin and creatinine levels, and were less likely to have dyslipidemia or to be a smoker. Multivariate analysis showed that the independent predictors of all-cause mortality at one year were age, diabetes, troponin-I level, Killip class > 1, male gender, creatinine level, and glomerular filtration rate. There was a linear correlation between increased risk and creatinine level.


CONCLUSIONS
Creatinine level at admission is one of the most important covariates in early prognostic stratification in these patients. A high serum creatinine level (or a low glomerular filtration rate) increases the probability of death due to all causes. The serum creatinine level is, moreover, an inexpensive, easy-to-use, and widely available prognostic marker.
Fácila
Lorenzo
L
Servicio de Cardiología, Hospital Clínico Universitario, Valencia, España.
Núñez
Julio
J
Bodí
Vicent
V
Sanchís
Juan
J
Bertomeu-González
Vicente
V
Consuegra
Luciano
L
Pellicer
Mauricio
M
Ferrero
Angel
A
Sanjuán
Rafael
R
Llácer
Angel
A
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D003404:Creatinine / Q000097:blood*; D003627:Data Interpretation, Statistical; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D051437:Renal Insufficiency / Q000150:complications / Q000175:diagnosis*; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
D015415:Biomarkers; D003404:Creatinine