title: The prognostic impact of in-hospital worsening of renal function in patients with acute coronary syndrome.
abstract: BACKGROUND
  Renal impairment is strongly linked to adverse cardiovascular (CV) events. Baseline renal dysfunction is a strong predictor of CV mortality and morbidity in patients admitted with acute coronary syndrome (ACS). However, the prognostic importance of worsening renal function (WRF) in these patients is not well characterized.
  
  
  METHODS
  ACS patients enrolled in the SPACE (Saudi Project for Assessment of Coronary Events) registry who had baseline and pre-discharge serum creatinine data available were eligible for this study. WRF was defined as a 25% reduction from admission estimated glomerular filtration rate (eGFR) within 7 days of hospitalization. Baseline demographics, clinical presentation, therapies, and in-hospital outcomes were compared.
  
  
  RESULTS
  Of the 3583 ACS patients, WRF occurred in 225 patients (6.3%), who were older, had more cardiovascular risk factors, were more likely to be female, have past vascular disease, and presented with more non-ST-segment elevation myocardial infarction than patients without WRF (39.5% vs. 32.8%; p=0.042). WRF was associated with an increased risk of in-hospital death, heart failure, cardiogenic shock, and stroke. After adjusting for potential confounders, WRF was an independent predictor of in-hospital death (adjusted odd ratio 28.02, 95% CI 13.2-60.28, p<0.0001). WRF was more predictive of mortality than baseline eGFR.
  
  
  CONCLUSIONS
  These results indicate that WRF is a powerful predictor for in-hospital mortality and CV complications in ACS patients.
authors.affiliation: Cardiac Sciences Department, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. halfaleh@ksu.edu.sa
authors.forename: Hussam F
authors.initials: HF
authors.lastname: AlFaleh
authors.forename: Abdulkareem O
authors.initials: AO
authors.lastname: Alsuwaida
authors.forename: Anhar
authors.initials: A
authors.lastname: Ullah
authors.forename: Ahmad
authors.initials: A
authors.lastname: Hersi
authors.forename: Khalid F
authors.initials: KF
authors.lastname: AlHabib
authors.forename: Khalid
authors.initials: K
authors.lastname: AlNemer
authors.forename: Shukri
authors.initials: S
authors.lastname: AlSaif
authors.forename: Amir
authors.initials: A
authors.lastname: Taraben
authors.forename: Tarek
authors.initials: T
authors.lastname: Kashour
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Balghith
authors.forename: Waqar H
authors.initials: WH
authors.lastname: Ahmed
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000639:trends; D007676:Kidney Failure, Chronic / Q000503:physiopathology; D007677:Kidney Function Tests / Q000639:trends; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012529:Saudi Arabia / Q000453:epidemiology