title: Temporal trends in management and outcomes of patients with acute coronary syndrome according to renal function.
abstract: BACKGROUND
  Recent new therapeutic options have improved outcomes of acute coronary syndrome (ACS) patients. However, data regarding the incremental effect of the improved treatment on patients with renal dysfunction are limited. We sought to evaluate temporal trends in management and outcome of ACS patients according to renal function.
  
  
  METHODS
  The study population consisted of all ACS patients enrolled in the Acute Coronary Syndromes Israeli Survey (ACSIS) during 2002-2013. Patients were categorized as normal renal function, mild to moderate and severe renal insufficiency. Patient's characteristics, clinical data and outcomes were compared in each group between 2 time frames - early (2002-2006) vs. late (2008-2013).
  
  
  RESULTS
  The study population included 11,234 patients. Regardless of renal function, patients enrolled in the recent surveys were more frequently selected for an invasive approach and were more commonly treated with guideline-based therapy. Among patients with normal renal function or mild to moderate renal dysfunction the improvement in treatment was associated with a significant reduction in 5-year mortality (10.1% vs. 12.6%, p=0.004, and 36% vs. 41.9%, p=0.01, respectively). On the other hand, outcomes of patients with severe renal insufficiency were unchanged. Multivariate analysis showed that reperfusion was associated with 41% mortality reduction in patients with mild to moderate renal insufficiency (HR=0.59 CI 95 0.48-0.72, p<0.01%).
  
  
  CONCLUSIONS
  Treatment of ACS patients has improved over the past decade. Treatment improvement was associated with a significant mortality reduction in patients with normal renal function and mild to moderate renal dysfunction but not in patients with severe renal dysfunction.
authors.affiliation: Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Electronic address: monysh@gmail.com.
authors.forename: Mony
authors.initials: M
authors.lastname: Shuvy
authors.affiliation: Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Dina
authors.initials: D
authors.lastname: Vorobeichik
authors.affiliation: Department of Internal Medicine, Meir Medical Center, Kfar Saba, Israel.
authors.forename: Eilon
authors.initials: E
authors.lastname: Krashin
authors.affiliation: Department of Cardiology, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Shlomo
authors.affiliation: Department of Cardiology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: Cardiology Department, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Pereg
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000401:mortality / Q000628:therapy*; D000368:Aged; D002423:Cause of Death / Q000639:trends; D003404:Creatinine / Q000378:metabolism; D019468:Disease Management; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007557:Israel / Q000453:epidemiology; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D011379:Prognosis; D051437:Renal Insufficiency / Q000150:complications* / Q000378:metabolism / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
chemical_list: D003404:Creatinine
keywords: Acute coronary syndrome; Outcomes; Renal insufficiency