Acute decline in renal function, inflammation, and cardiovascular risk after an acute coronary syndrome.
OBJECTIVE
Chronic kidney disease is associated with a higher risk of cardiovascular outcomes. The prognostic significance of worsening renal function has also been shown in various cohorts of cardiac disease; however, the predictors of worsening renal function and the contribution of inflammation remains to be established.


METHODS
Worsening renal function was defined as a 25% or more decrease in estimated GFR (eGFR) over a 1-mo period in patients after a non-ST or ST elevation acute coronary syndromes participating in the Aggrastat-to-Zocor Trial; this occurred in 5% of the 3795 participants.


RESULTS
A baseline C-reactive protein (CRP) in the fourth quartile was a significant predictor of developing worsening renal function (odds ratio, 2.48; 95% confidence interval, 1.49, 4.14). After adjusting for baseline CRP and eGFR, worsening renal function remained a strong multivariate predictor for the combined cardiovascular composite of CV death, recurrent myocardial infarction (MI), heart failure or stroke (hazard ratio, 1.6; 95% confidence interval, 1.1, 2.3).


CONCLUSIONS
Patients with an early decline in renal function after an acute coronary syndrome are at a significant increased risk for recurrent cardiovascular events. CRP is an independent predictor for subsequent decline in renal function and reinforces the idea that inflammation may be related to the pathophysiology of progressive renal disease.
Mielniczuk
Lisa M
LM
University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada. lmielniczuk@ottawaheart.ca
Pfeffer
Marc A
MA
Lewis
Eldrin F
EF
Blazing
Michael A
MA
de Lemos
James A
JA
Mohanavelu
Satishkumar
S
Rouleau
Jean
J
Fox
Keith
K
Pedersen
Terje R
TR
Califf
Robert M
RM
D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000401:mortality*; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007249:Inflammation / Q000175:diagnosis / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D007677:Kidney Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D012307:Risk Factors; D019821:Simvastatin / Q000627:therapeutic use; D016896:Treatment Outcome
D004232:Diuretics; D000960:Hypolipidemic Agents; D002097:C-Reactive Protein; D019821:Simvastatin