title: Renal dysfunction, coronary revascularization and mortality among elderly patients with non ST elevation acute coronary syndrome.
abstract: OBJECTIVE
  To determine the association between baseline creatinine clearance (CrCl), coronary revascularization during index admission, and 1-year mortality in elderly patients with an acute coronary syndrome (ACS).
  
  
  RESULTS
  We estimated CrCl using the Cockcroft-Gault (CG) formula in 313 patients aged ≥ 75 years enrolled in a prospective study of treatment strategies in non ST-elevation ACS (NSTEACS). Patients were stratified into four groups according to CrCl on admission (using a cutoff of 45 ml/min) and coronary revascularization versus medical management. The mean age of the study population was 81 years and the median serum creatinine level on admission was 1.0 mg/dl (interquartile range (IQR) 0.8-1.3). Patients with impaired renal function treated medically had higher in-hospital and 1-year mortality, especially if compared with patients with preserved renal function undergoing revascularization (1-year mortality 22.9% versus 4.9%). Across the spectrum of CrCl categories, coronary revascularization was independently associated with a lower risk of mortality (HR 0.405; 95% CI 0.174-0.940; p=0.035).
  
  
  CONCLUSIONS
  In elderly patients with NSTEACS, coronary revascularization decreases the risk of 1-year death across each CrCl category, and is one of the most powerful predictors of 1-year outcome.
authors.affiliation: Azienda Ospedaliera Ospedale Niguarda Cà Granda, Italy nuccia.morici@ospedaleniguarda.it.
authors.forename: Nuccia
authors.initials: N
authors.lastname: Morici
authors.affiliation: IRCCS Policlinico S. Matteo, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
authors.affiliation: Ospedale Misericordia e Dolce, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Toso
authors.affiliation: Ospedale S Maria delle Grazie, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Murena
authors.affiliation: Università di Salerno, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Piscione
authors.affiliation: Ospedale San Donato, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Bolognese
authors.affiliation: Azienda Ospedaliera Universitaria Pisana, Italy.
authors.forename: Anna Sonia
authors.initials: AS
authors.lastname: Petronio
authors.affiliation: INRCA, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Antonicelli
authors.affiliation: Azienda Ospedaliera Ospedale Santa Maria della Misericordia, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Cavallini
authors.affiliation: Azienda Ospedaliera Ospedale Santa Maria della Misericordia, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Angeli
authors.affiliation: Azienda Ospedaliera della Provincia di Lecco, Ospedale A. Manzoni, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Savonitto
mesh_terms: D054058:Acute Coronary Syndrome / Q000378:metabolism / Q000401:mortality / Q000601:surgery*; D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D017023:Coronary Angiography; D003404:Creatinine / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000378:metabolism / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000706:statistics & numerical data; D011379:Prognosis; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000175:diagnosis / Q000378:metabolism / Q000401:mortality*; D012307:Risk Factors
chemical_list: D003404:Creatinine
keywords: acute myocardial infarction; chronic; percutaneous coronary intervention; renal disease