Impact of impaired renal function and diabetes on long-term prognosis in patients undergoing primary angioplasty for acute coronary syndrome.
OBJECTIVE
We sought to determine the effect of impaired renal function (IRF) and diabetes on the long-term outcome in patients undergoing primary angioplasty for acute coronary syndrome (ACS). Background Diabetes and IRF occur frequently in patients presenting with ACS. However, the prognostic importance of IRF in comparison with diabetes after primary angioplasty has not been specifically studied.


METHODS
A total of 742 patients with ACS treated by primary angioplasty were evaluated. Study endpoints were major adverse cardiac events (MACE), a composite of all-cause mortality, ACS, and target vessel revascularization (TVR).


RESULTS
During an average follow-up period of 6.8 years, we documented 13 cardiovascular deaths, 27 non-cardiovascular deaths, 12 incidents of ACS, and 165 incidences of TVR. Six-year rates of MACE were significantly higher in diabetics with IRF (47.6%), nondiabetics with IRF (36.4%), and diabetics without IRF (36.0%) than in nondiabetics without IRF (28.4%, Log-rank test: p=0.0057). Nondiabetics with IRF, diabetics without IRF, and diabetics with IRF had a relative hazard ratio for MACE of 1.63 (95% confidence interval (CI) 1.04 to 2.54, p=0.033), 1.47 (95% CI, 1.03 to 2.11; p=0.036), and 1.97 (95% CI, 1.12 to 3.48; p=0.019), respectively, compared with nondiabetics without IRF.


CONCLUSIONS
IRF has an important association with MACE after primary angioplasty in patients with ACS and may be nearly as predictive of long-term outcome as is diabetes.
Goto
Kenji
K
Department of Cardiology, Matsue Red Cross Hospital, Matsue. kenji-g@go4.enjoy.ne.jp
Shiode
Nobuo
N
Shirota
Kinya
K
Fukuda
Yukihiro
Y
Kitamura
Fumiyo
F
Tominaga
Koichi
K
Kato
Yasuko
Y
D054058:Acute Coronary Syndrome / Q000150:complications / Q000601:surgery*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003928:Diabetic Nephropathies / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D015607:Stents