title: Incidence, Mortality and Positive Predictive Value of Type 1 Cardiorenal Syndrome in Acute Coronary Syndrome.
abstract: OBJECTIVE
  To determine whether the risk of cardiovascular mortality associated with cardiorenal syndrome subtype 1 (CRS1) in patients who were hospitalized for acute coronary syndrome (ACS) was greater than the expected risk based on the sum of its components, to estimate the predictive value of CRS1, and to determine whether the severity of CRS1 worsens the prognosis.
  
  
  METHODS
  Follow-up study of 1912 incident cases of ACS for 1 year after discharge. Cox regression models were estimated with time to event (in-hospital death, and readmission or death during the first year after discharge) as the dependent variable.
  
  
  RESULTS
  The incidence of CRS1 was 9.2/1000 person-days of hospitalization (95% CI = 8.1-10.5), but these patients accounted for 56.6% (95% CI = 47.4-65.) of all mortality. The positive predictive value of CRS1 was 29.6% (95% CI = 23.9-36.0) for in-hospital death, and 51.4% (95% CI = 44.8-58.0) for readmission or death after discharge. The risk of in-hospital death from CRS1 (RR = 18.3; 95% CI = 6.3-53.2) was greater than the sum of risks associated with either acute heart failure (RR = 7.6; 95% CI = 1.8-31.8) or acute kidney injury (RR = 2.8; 95% CI = 0.9-8.8). The risk of events associated with CRS1 also increased with syndrome severity, reaching a RR of 10.6 (95% CI = 6.2-18.1) for in-hospital death at the highest severity level.
  
  
  CONCLUSIONS
  The effect of CRS1 on in-hospital mortality is greater than the sum of the effects associated with each of its components, and it increases with the severity of the syndrome. CRS1 accounted for more than half of all mortality, and its positive predictive value approached 30% in-hospital and 50% after discharge.
authors.affiliation: Servicio de Cardiología. Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Pimienta González
authors.affiliation: Servicio de Cardiología. Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Couto Comba
authors.affiliation: Servicio de Cardiología. Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain.
authors.forename: Marcos
authors.initials: M
authors.lastname: Rodríguez Esteban
authors.affiliation: Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain.|Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: José Juan
authors.initials: JJ
authors.lastname: Alemán Sánchez
authors.affiliation: Servicio de Cardiología. Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Hernández Afonso
authors.affiliation: Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain.|Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: María Del Cristo
authors.initials: MD
authors.lastname: Rodríguez Pérez
authors.affiliation: Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain.|Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Itahisa
authors.initials: I
authors.lastname: Marcelino Rodríguez
authors.affiliation: Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain.|Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Buenaventura
authors.initials: B
authors.lastname: Brito Díaz
authors.affiliation: Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.|Epidemiología Cardiovascular y Genética, IMIM. Barcelona, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Elosua
authors.affiliation: Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain.|Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.|Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Cabrera de León
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications*; D000368:Aged; D000369:Aged, 80 and over; D059347:Cardio-Renal Syndrome / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors