title: Renal insufficiency increases mortality in acute coronary syndromes regardless of TIMI risk score.
abstract: BACKGROUND
  Non ST-segment elevation acute coronary syndromes (NSTE ACS) are the most frequent cause of admission to intensive care units. Early risk assessment and implementation of optimal treatment are of special importance in these patients. Previous studies have demonstrated that renal insufficiency is an independent risk factor in patients with cardiovascular disease.
  
  
  OBJECTIVE
  To assess the effects of renal function on the course of treatment and prognosis in patients with NSTE ACS admitted to hospitals without on-site invasive facilities but with a possibility of immediate transfer to a reference centre with a catheterisation laboratory.
  
  
  METHODS
  Twenty-nine community hospitals without on-site invasive facilities participated in the Krakow Registry of Acute Coronary Syndromes - a prospective, multicentre, web-based, observational registry. Renal insufficiency (RI) was defined as creatinine clearance (CrCl) <60 ml/min.
  
  
  RESULTS
  NSTE ACS was diagnosed in 1396 patients. Renal insufficiency was diagnosed in 34% of all patients. Only 17% of them had been diagnosed with RI prior to admission. Transfer for invasive treatment was undertaken in 10% of RI patients as compared to 16% of patients with CrCl >60 ml/min (NS). In-hospital mortality among patients remaining on conservative treatment in community hospitals was significantly higher among RI patients (4.0 vs. 0.6%; p <0.001). Thienopyridines were less frequently used in RI patients (46 vs. 54%; p <0.05). In-hospital mortality among RI patients remaining in community hospitals and treated conservatively was higher than among non-RI patients in each TIMI risk score group: 7.3 vs. 2.4% (p <0.05) in the high risk group, 4.1 vs. 1.4% (NS) in the moderate and 3.6 vs. 0% (p <0.001) in the low risk group. Multivariate logistic regression analysis identified reduced creatinine clearance and a history of heart failure as independent factors influencing mortality.
  
  
  CONCLUSIONS
  Renal insufficiency was present in one-third of NSTE ACS patients. Patients with renal insufficiency had worse clinical risk profile and received less aggressive treatment. Patients with NSTE ACS and renal insufficiency treated conservatively had higher in-hospital mortality. Renal insufficiency modifies mortality irrespective of the TIMI risk score. Creatinine clearance should be considered in modification of the TIMI risk score scale.
authors.affiliation: Instytut Kardiologii, CM UJ, ul. Kopernika 17, 31-501 Kraków. mcdudek@cyf-kr.edu.pl
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
authors.forename: Bernadeta
authors.initials: B
authors.lastname: Chyrchel
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Siudak
authors.forename: Rafał
authors.initials: R
authors.lastname: Depukat
authors.forename: Michał
authors.initials: M
authors.lastname: Chyrchel
authors.forename: Artur
authors.initials: A
authors.lastname: Dziewierz
authors.forename: Waldemar
authors.initials: W
authors.lastname: Mielecki
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rakowski
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Rzeszutko
authors.forename: Jacek
authors.initials: J
authors.lastname: Dubiel
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006305:Health Status Indicators; D017052:Hospital Mortality; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D012307:Risk Factors
chemical_list: D003404:Creatinine