[In-hospital prognostic value of glomerular filtration rate in patients with acute coronary syndrome and a normal creatinine level].
OBJECTIVE
Kidney failure is more prevalent in patients with ischemic heart disease than in the general population. A high serum creatinine level is known to be a predictor of an adverse outcome in acute coronary syndrome. The aim of this study was to investigate the clinical significance of the glomerular filtration rate in patients with acute coronary syndrome and a normal baseline creatinine level.


METHODS
The study included 583 consecutive patients admitted to a coronary care unit with acute coronary syndrome (with or without ST-segment elevation) whose baseline serum creatinine level was less than 1.3 mg/dL. The creatinine clearance rate at admission was calculated using the Cockcroft-Gault equation, and the presence of cardiovascular risk factors, coronary anatomy (from angiography), type of revascularization, maximum cardiac enzyme levels, left ventricular ejection fraction and, ultimately, in-hospital mortality were recorded.


RESULTS
Around 50.8% of patients presented with ST-segment elevation acute coronary syndrome. The median serum creatinine level on admission was 0.98 mg/dL (0.9-1.1 mg/dL) and the median creatinine clearance rate was 81.29 mL/min (61.2-98.4 mL/min). The in-hospital mortality rate was 2.7%. Glomerular filtration rate, previous coronary disease, Killip class on admission, and the need for intraaortic balloon counterpulsation were found to be independent predictors of mortality.


CONCLUSIONS
In patients with acute coronary syndrome and a normal creatinine level on admission, estimation of the glomerular filtration rate provided important information on short-term prognosis. This parameter should be included in the risk assessment of patients with normal serum creatinine levels.
Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico Universitario San Carlos, Madrid, España. rocicarda@hotmail.com
Rocío
R
Carda Barrio
José A
JA
de Agustín
María C
MC
Manzano
Juan C
JC
García-Rubira
Antonio
A
Fernández-Ortiz
Isidre
I
Vilacosta
Carlos
C
Macaya
D000208:Acute Disease; D000368:Aged; D000789:Angina, Unstable / Q000097:blood* / Q000401:mortality / Q000503:physiopathology*; D003404:Creatinine / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality / Q000503:physiopathology*; D011379:Prognosis; D013577:Syndrome
D003404:Creatinine