Impact of renal dysfunction on clinical outcomes of acute coronary syndrome.
OBJECTIVE
The present study aimed to compare the clinical outcomes and to investigate prognostic factors of acute coronary syndrome (ACS) in patients with renal dysfunction (RD).


METHODS
The study was a retrospective cohort of 648 adult patients admitted with ACS between October 2005 and December 2006. The estimated glomerular filtration rate (GFR) was classified into 4 levels: 1) normal, GFR greater than 90 mL/min/1.73 m(2); 2) mild RD, GFR of 60 to 90 mL/min/1.73 m(2); 3) moderate RD, GFR of 30 to 60 mL/min/1.73 m(2); and 4) severe RD, GFR less than 30 mL/min/1.73 m(2). Primary end points were death and complication in hospital courses. Secondary end points were major adverse cardiac event (MACE) during follow-up.


RESULTS
The median follow-up was 505 +/- 183 days, the mean age was 63 +/- 12 years, and 71.8 percent of the group were men. A graded association was observed between severity of RD and clinical outcomes. Severe RD independently predicted MACE [hazard ratio, 2.731; 95% confidence interval (CI), 1.058 to 7.047, p = 0.038]. Low hemoglobin level was also an independent risk factor for MACE (hazard ratio, 1.155; 95% CI, 1.020 to 1.307, p = 0.022). Use of lipid-lowering therapy (hazard ratio, 0.456; 95% CI, 0.242 to 0.857, p = 0.015) was associated with reduced risk for MACE.


CONCLUSIONS
Severe RD and low hemoglobin level were an independent risk factors for the mortality and complications of ACS, while lipid-lowering therapy was associated with reduced risk.
Kang
Yong Un
YU
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Jeong
Myung Ho
MH
Kim
Soo Wan
SW
D054058:Acute Coronary Syndrome / Q000473:pathology*; D000368:Aged; D017023:Coronary Angiography; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007674:Kidney Diseases / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors