title: Impact of renal dysfunction on clinical outcomes of acute coronary syndrome.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Yong Un
authors.initials: YU
authors.lastname: Kang
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Soo Wan
authors.initials: SW
authors.lastname: Kim
mesh_terms: 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