Relative performance of three formulas to assess renal function at predicting in-hospital hemorrhagic complications in an acute coronary syndrome population. What does the new CKD-EPI formula provide?
OBJECTIVE
Assessment of renal function is important for bleeding risk stratification in acute coronary syndrome (ACS). There are three formulas routinely used to assess renal function: the Cockroft-Gault (C-G) formula, the MDRD-4 formula and the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Our aim was to compare the ability of these formulas to predict the risk of in-hospital bleeding in patients with ACS.


METHODS
The study included 3270 patients with ACS. The performance of each formula with respect to in-hospital TIMI (Thrombolysis In Myocardial Infarction) major or TIMI minor bleeding were assessed using continuous data and by dividing patients into four subgroups according to the estimated glomerular filtration rate (eGFR): ≥90, 89-60, 30-59 and <30 ml/min/1.73 m(2).


RESULTS
Bleeding predictive ability was significantly higher for the C-G formula than for MDRD-4 and CKD-EPI formulas, as evaluated by the area under the curve (AUC); continuous eGFR AUCs: 0.73, 0.69 and 0.71, respectively; categorical eGFR AUCs: 0.71, 0.66 and 0.68, respectively. Net reclassification improvement based on the eGFR categories was significantly positively favored C-G: 9.5% (95% confidence interval (CI) 1.8-17.2%) and 19.1% (95% CI 11.3-26.9%) compared with CKD-EPI and MDRD-4, respectively. After multivariable adjustment, the C-G formula predicted in-hospital bleeding better than MDRD-4 formula (severe renal dysfunction vs. normal renal function: odds ratio 7.98, 95% CI 2.61-24.38 with C-G; odds ratio 3.76, 95% CI 1.63-8.69 with MDRD-4; and odds ratio 5.77, 95% CI 2.18-15.24 with CKD-EPI.


CONCLUSIONS
Our findings suggest that the C-G eGFR may improve risk prediction of in-hospital bleeding more than the MDRD-4 equation and the new CKD-EPI equation in patients with ACS.
Cardiology Department, University Clinical Hospital of Santiago, Spain.
Pilar
P
Cabanas-Grandío
Cardiology Department, University Clinical Hospital of Santiago, Spain eabuassi@yahoo.es.
Emad
E
Abu-Assi
Cardiology Department, University Clinical Hospital of Santiago, Spain.
Sergio
S
Raposeiras-Roubin
Cardiology Department, University Clinical Hospital of Santiago, Spain.
Belén
B
Alvarez-Alvarez
Cardiology Department, University Clinical Hospital of Santiago, Spain.
Cristina
C
González-Cambeiro
Cardiology Department, University Clinical Hospital of Santiago, Spain.
Santiago Gestal
SG
Romaní
Cardiology Department, University Clinical Hospital of Santiago, Spain.
Eva
E
Pereira-López
Cardiology Department, University Clinical Hospital of Santiago, Spain.
Noelia
N
Bouzas-Cruz
Cardiology Department, University Clinical Hospital of Santiago, Spain.
Andrea
A
López-López
SiDOR Research Group, University of Vigo, Campus Lagoas-Marcosende, Spain.
Mar
M
Rodríguez-Girondo
Cardiology Department, University Clinical Hospital of Santiago, Spain.
Milagros
M
Pedreira
Cardiology Department, University Clinical Hospital of Santiago, Spain.
José María
JM
García-Acuña
Cardiology Department, University Clinical Hospital of Santiago, Spain.
José Ramón
JR
González-Juanatey
D054058:Acute Coronary Syndrome / Q000150:complications* / Q000503:physiopathology; D000368:Aged; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007677:Kidney Function Tests / Q000592:standards*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000503:physiopathology; D011237:Predictive Value of Tests; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods / Q000592:standards
Renal function; acute coronary syndrome; bleeding