Estimated glomerular filtration rate, inflammation, and cardiovascular events after an acute coronary syndrome.
Both renal dysfunction and elevated levels of high-sensitivity C-reactive protein (CRP) are associated with a higher risk of cardiovascular (CV) outcomes. However, it remains to be established whether the prognostic value of impaired estimated glomerular filtration rate (GFR) remains after accounting for markers of inflammation.


RESULTS
Glomerular filtration rate was estimated using the Modification of Diet in Renal Disease equation in 4178 patients with non-ST or ST-elevation acute coronary syndromes, participating in the A to Z trial. The mean estimated GFR was 68 mL/min, with a median baseline CRP of 20.2 mg/L. Both an estimated GFR <60 mL/min (HR 2.13, 95% CI 1.7-2.6) and a CRP in the fourth quartile (HR 1.7, 95% CI 1.4-2.2) were strong univariate predictors of a CV event (composite of CV death, recurrent myocardial infarction, heart failure, or stroke). After adjusting for baseline CRP, GFR <60 mL/min remained a strong multivariate predictor for CV death (HR 1.82, 95% CI 1.1-2.97). Randomization to high-dose statin therapy was associated with a reduction in the CV composite (adjusted HR 0.69, 95% CI 0.5-0.95) irrespective of baseline renal function.


CONCLUSIONS
In a population of patients without overt renal disease, moderate reductions in estimated GFR remain an important prognostic marker. This increased CV hazard associated with an estimated GFR <60 mL/min is independent and additive to markers of inflammation.
Mielniczuk
Lisa M
LM
University of Ottawa Heart Institute, Ottawa, Ontario, Canada. lmielniczuk@ottawaheart.ca
Pfeffer
Marc A
MA
Lewis
Eldrin F
EF
Blazing
Michael A
MA
de Lemos
James A
JA
Shui
Amy
A
Mohanavelu
Satish
S
Califf
Robert M
RM
Braunwald
Eugene
E
D054058:Acute Coronary Syndrome / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology*; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D015897:Comorbidity; D004311:Double-Blind Method; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007249:Inflammation; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012008:Recurrence
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002097:C-Reactive Protein