Impact of impaired glomerular filtration rate and revascularization strategy on one-year cardiovascular events in acute coronary syndrome: data from Taiwan acute coronary syndrome full spectrum registry.
BACKGROUND
The optimal revascularization strategy for patients with impaired glomerular filtration rate (IGFR) has not been established in acute coronary syndrome (ACS). We investigated the prognosis and impact of IGFR and invasive strategy on the cardiovascular outcomes in the ACS population.


METHODS
In a Taiwan national-wide registry, 3093 ACS patients were enrolled. The invasive strategy was defined as patients with ST-elevation ACS (STE-ACS) undergoing primary angioplasty or fibrinolysis or coronary angiography with intent to revascularization performed within 72 hours of symptom onset in non-ST-elevation ACS (NSTE-ACS). IGFR was defined as an estimated GFR of less than 60 ml/min per 1.73 m2. Primary endpoint was a composite of death, non-fatal myocardial infarction or stroke at one year.


RESULTS
Patients with IGFR (n = 1226) had more comorbidities but received less evidence-based medications during admission than those without IGFR (n = 1867). The primary endpoint-free survival rate is lower in the IGFR patients, in the whole, STE-ACS and NSTE-ACS population (all log-rank tests p < 0.01). Cox regression analysis revealed IGFR subjects had higher primary endpoint after adjusting by age, sex, medication at discharge and traditional risk factors (all p < 0.01). Kaplan-Meier curves showed IGFR patients without invasive strategy had the worst outcome in the STE-ACS and NSTE-ACS population (both p < 0.01). The invasive strategies, either with early angiography only or angioplasty, were associated with reduced primary endpoints among IGFR patients in the NSTE-ACS population (both p ≦ 0.024).


CONCLUSIONS
IGFR patients suffering from ACS had poor prognosis and an invasive strategy could improve cardiovascular outcome in the NSTE-ACS population.
Tsung-Hsien
TH
Lin
Ho-Tsung
HT
Hsin
Chun-Li
CL
Wang
Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, No,100, Tzyou 1st Road, Kaohsiung 80708, Taiwan. wtlai@cc.kmu.edu.tw.
Wen-Ter
WT
Lai
Ai-Hsien
AH
Li
Chi-Tai
CT
Kuo
Juey-Jen
JJ
Hwang
Fu-Tien
FT
Chiang
Shu-Chen
SC
Chang
Chee-Jen
CJ
Chang
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D015984:Causality; D015897:Comorbidity; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000401:mortality*; D012307:Risk Factors; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome