title: Renal dysfunction as a predictor of long-term mortality in middle-aged women following an acute coronary syndrome.
abstract: OBJECTIVE
  To evaluate the association between renal dysfunction and long-term prognosis among middle-aged women surviving an acute coronary syndrome (ACS).
  
  
  METHODS
  The Stockholm Female Coronary Risk Study included 291 women <66 years of age, hospitalized for an ACS during the years 1991-1994 in the greater Stockholm area. All patients underwent clinical screening for cardiovascular prognostic factors, including blood samples 3 to 6 months after the event. Creatinine clearance (CCr) was calculated using the Cockcroft-Gaults formula and related to adverse outcome. Hazard ratios (HR) for all-cause and cardiovascular mortality, respectively, in each tertile of CCr, were estimated using Cox proportional hazards regression.
  
  
  RESULTS
  There were 40 deaths, including 23 from cardiovascular causes, during a median follow-up of 9 years. The unadjusted HRs for all-cause mortality for the 1st (CCr < 78 mL/min) and 2nd (CCr 78-96 mL/min) tertiles of CCr were 3.17 (95% confidence interval [CI] 1.34-7.45) and 1.76 (95% CI 0.69-4.48), respectively, compared with the 3rd (CCr > 96 mL/min) tertile. The corresponding HRs for cardiovascular mortality were 3.66 (95% CI 1.20-11.1) and 1.28 (95% CI 0.34-4.76). After multivariable adjustment for potential confounders, the association between all-cause mortality and CCr in the 1st compared with the 3rd tertile remained statistically significant (HR 4.37, 95% CI 1.39-13.7).
  
  
  CONCLUSIONS
  Renal dysfunction is related to long-term mortality in middle-aged women hospitalized for ACS.
authors.affiliation: Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden. martin.holzmann@karolinska.se
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Holzmann
authors.forename: Imre
authors.initials: I
authors.lastname: Janszky
authors.forename: Faris
authors.initials: F
authors.lastname: Al-Khalili
authors.forename: Karin
authors.initials: K
authors.lastname: Schenck-Gustafsson
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000401:mortality; D002318:Cardiovascular Diseases / Q000401:mortality*; D003404:Creatinine / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000150:complications*
chemical_list: D003404:Creatinine