title: Examining renal impairment as a risk factor for acute coronary syndrome: a prospective observational study.
abstract: OBJECTIVE
  This study seeks to examine whether the finding of an abnormal estimated glomerular filtration rate (eGFR) in the emergency department (ED) was associated with acute coronary syndrome in the population of patients presenting for investigation of chest pain.
  
  
  METHODS
  We used prospectively collected data on adult patients presenting with suspected acute coronary syndrome to 2 EDs in Australia and New Zealand. Trained research nurses collected clinical data with a customized case report form. Creatinine measurements were taken on presentation, and the glomerular filtration rate ([GFR]; milliliters per minute per 1.73 m(2)) was estimated with the chronic kidney disease epidemiologic collaboration equation. The primary endpoint was acute coronary syndrome within 30 days of presentation, as adjudicated by cardiologists using standardized guidelines. Logistic regression analyses examined the relationship between eGFR and acute coronary syndrome.
  
  
  RESULTS
  Acute coronary syndrome was diagnosed in 421 (21%) of the 1,968 patients recruited. Compared with patients with an eGFR greater than 90 mL/minute per 1.73 m(2), patients with an eGFR between 60 and 90 mL/minute per 1.73 m(2) and patients with an eGFR less than 60 mL/minute per 1.73 m(2) were 1.64 (95% confidence interval 1.10 to 2.44) and 1.70 (95% confidence interval 1.01 to 2.77) times more likely to receive a diagnosis of acute coronary syndrome after controlling for age, sex, hypertension, dyslipidemia, family history of cardiac disease, diabetes, patient history of cardiac disease, cardiac troponin level, and ECG findings.
  
  
  CONCLUSIONS
  There is an independent association between eGFR and acute coronary syndrome risk in patients presenting to the ED with chest pain; this association is independent of age, traditional cardiac risk factors, medical history, troponin level, and ECG findings. Reduced eGFR should be considered an acute coronary syndrome risk factor, and clinicians should maintain high clinical suspicion for acute coronary syndrome in patients with abnormal renal function results regardless of whether they have known kidney disease, traditional acute coronary syndrome risk factors, or abnormal diagnostic test results. Risk stratification tools should include reduced eGFR as a high-risk feature.
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia. jaimi_greenslade@health.qld.gov.au
authors.forename: Jaimi H
authors.initials: JH
authors.lastname: Greenslade
authors.forename: Louise
authors.initials: L
authors.lastname: Cullen
authors.forename: Lauren
authors.initials: L
authors.lastname: Kalinowski
authors.forename: William
authors.initials: W
authors.lastname: Parsonage
authors.forename: Suetonia
authors.initials: S
authors.lastname: Palmer
authors.forename: Sally
authors.initials: S
authors.lastname: Aldous
authors.forename: Mark
authors.initials: M
authors.lastname: Richards
authors.forename: Kevin
authors.initials: K
authors.lastname: Chu
authors.forename: Anthony F T
authors.initials: AF
authors.lastname: Brown
authors.forename: Richard
authors.initials: R
authors.lastname: Troughton
authors.forename: Chris
authors.initials: C
authors.lastname: Pemberton
authors.forename: Martin
authors.initials: M
authors.lastname: Than
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D017677:Age Distribution; D000368:Aged; D001315:Australia; D015897:Comorbidity; D016001:Confidence Intervals; D016208:Databases, Factual; D004635:Emergency Medicine / Q000379:methods; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D016017:Odds Ratio; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D018570:Risk Assessment; D017751:Safety Management; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate