title: The prognostic impact of worsening renal function in Japanese patients undergoing percutaneous coronary intervention with acute coronary syndrome.
abstract: BACKGROUND
  The prognostic impact of worsening renal function (WRF) in acute coronary syndrome (ACS) patients is not fully understood in Japanese clinical practice, and clinical implication of persistent versus transient WRF in ACS patients is also unclear.
  
  
  METHODS
  With a single hospital-based cohort in the Shinken database 2004-2012 (n=19,994), we followed 604 ACS patients who underwent percutaneous coronary intervention (PCI). WRF was defined as an increase in creatinine during hospitalization of ≥0.3mg/dl above admission value. Persistent WRF was defined as an increase in creatinine during hospitalization of ≥0.3mg/dl above admission value and maintained until discharge, whereas transient WRF was defined as that WRF resolved at hospital discharge.
  
  
  RESULTS
  WRF occurred in 78 patients (13%), persistent WRF 35 patients (6%) and transient WRF 43 patients (7%). WRF patients were older and had a higher prevalence of chronic kidney disease, history of myocardial infarction (MI), and ST elevation MI. WRF was associated with elevated inflammatory markers and reduced left ventricular (LV) ejection fraction in acute, chronic phase. Incidence of all-cause death and major adverse cardiac events (MACE: all-cause death, MI, and target lesion revascularization) was significantly higher in patients with WRF. Moreover, in the WRF group, incidences of all-cause death and MACE were higher in patients with persistent WRF than those with transient WRF. A multivariate analysis showed that as well as older age, female gender, and intubation, WRF was an independent determinant of the all-cause death in ACS patients who underwent PCI.
  
  
  CONCLUSIONS
  In conclusion, WRF might have a prognostic impact among Japanese ACS patients who underwent PCI in association with enhanced inflammatory response and LV remodeling. Persistent WRF might portend increased events, while transient WRF might have association with favorable outcomes compared with persistent WRF.
authors.affiliation: The Cardiovascular Institute, Tokyo, Japan. Electronic address: murata@cvi.or.jp.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Murata
authors.affiliation: The Cardiovascular Institute, Tokyo, Japan.
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Kaneko
authors.affiliation: The Cardiovascular Institute, Tokyo, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Yajima
authors.affiliation: The Cardiovascular Institute, Tokyo, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Oikawa
authors.affiliation: The Cardiovascular Institute, Tokyo, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Oshima
authors.affiliation: The Cardiovascular Institute, Tokyo, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: The Cardiovascular Institute, Tokyo, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kano
authors.affiliation: The Cardiovascular Institute, Tokyo, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Matsuno
authors.affiliation: The Cardiovascular Institute, Tokyo, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: The Cardiovascular Institute, Tokyo, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kato
authors.affiliation: The Cardiovascular Institute, Tokyo, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Otsuka
authors.affiliation: The Cardiovascular Institute, Tokyo, Japan.
authors.forename: Tokuhisa
authors.initials: T
authors.lastname: Uejima
authors.affiliation: The Cardiovascular Institute, Tokyo, Japan.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nagashima
authors.affiliation: The Cardiovascular Institute, Tokyo, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Kirigaya
authors.affiliation: The Cardiovascular Institute, Tokyo, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Sagara
authors.affiliation: The Cardiovascular Institute, Tokyo, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sawada
authors.affiliation: The Cardiovascular Institute, Tokyo, Japan.
authors.forename: Tadanori
authors.initials: T
authors.lastname: Aizawa
authors.affiliation: The Cardiovascular Institute, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamashita
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D006760:Hospitalization; D006801:Humans; D007564:Japan; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D010351:Patient Discharge / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D015995:Prevalence; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000209:etiology; D016277:Ventricular Function, Left
chemical_list: D003404:Creatinine
keywords: Acute coronary syndrome; Enhanced inflammatory response; Left ventricular remodeling; Worsening renal function