title: Relationship between coronary artery disease and C-reactive protein levels in NSTEMI patients with renal dysfunction: a retrospective study.
abstract: BACKGROUND
  While chronic renal damage is a condition with low-grade inflammation, the potential role of inflammation in kidney disease as a marker of cardiovascular damage is of current interest. This study analyzed the relationship between renal dysfunction, chronic inflammation, and extension of coronary atherosclerosis in patients with non-ST-segment elevation myocardial infarction (NSTEMI).
  
  
  METHODS
  This retrospective study was carried out on consecutive patients presenting with NSTEMI to Maggiore Hospital's emergency department between January 1, 2010 and December 31, 2011. Patients' electronic charts were reviewed to gather information on patients' history, clinical and biochemical variables, with a special focus on inflammatory markers, coronary vessel damage, and drug treatments.
  
  
  RESULTS
  Of the 320 individuals in the study population, 138 (43.1%) had an admission GFR <60 mL/min/1.73 m2. Kidney dysfunction was significantly associated with age (OR = 1.09, 95% CI 1.06 to 1.12), history of heart failure (OR = 2.13, 95% CI 1.08 to 4.17), and hypertension (OR = 2.31, 95% 1.12 to 4.74). C-reactive protein (CRP) and uric acid levels were significantly increased in patients with severe renal dysfunction (SRD) by bivariate and multivariate analyses, adjusted for gender, age and comorbidities at admission. The extent of coronary artery disease (CAD) was significantly higher in the SRD group (p < 0.001). Individuals with SRD were less likely to receive immediate evidence-based therapies (62.9% vs. 76.7% and 82.0% in those with intermediate and no/mild renal dysfunction, p < 0.001). Hospital stay was significantly longer in individuals with a greater extent of CAD, diabetes, and a history of heart failure, and was borderline significantly associated with renal dysfunction (p = 0.08). Older age, CAD severity, and renal function were associated with worsening GFR during hospitalization, whereas immediate evidence-based treatment was unrelated to a GFR change.
  
  
  CONCLUSIONS
  Among individuals hospitalized for NSTEMI, those with SRD had a more extensive CAD and a higher prevalence of pre-existing cardiovascular disease. CRP was positively correlated with renal dysfunction and the number of involved coronary vessels, confirming its potential as a biomarker. Uric acid was associated with renal dysfunction but not with the number of diseased coronary vessels.
authors.forename: Maria
authors.initials: M
authors.lastname: Udeanu
authors.forename: Giordano
authors.initials: G
authors.lastname: Guizzardi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Pasquale
authors.forename: Antonio
authors.initials: A
authors.lastname: Marchetti
authors.forename: Francesca
authors.initials: F
authors.lastname: Romani
authors.forename: Vittorio
authors.initials: V
authors.lastname: Dalmastri
authors.forename: Irene
authors.initials: I
authors.lastname: Capelli
authors.forename: Lucia
authors.initials: L
authors.lastname: Stalteri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cianciolo
authors.forename: Paola
authors.initials: P
authors.lastname: Rucci
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Nephrology Dialysis and Transplantation Unit, S, Orsola Hospital, University of Bologna, Bologna, Italy. gaetano.lamanna@unibo.it.
authors.forename: Gaetano
authors.initials: G
authors.lastname: La Manna
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D003324:Coronary Artery Disease / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein