Association of Creatinine Clearance and In-Hospital Mortality in Patients With Acute Coronary Syndromes

Abstract

revious studies have demonstrated that renal insufficiency is an independent risk factor for cardiovascular morbidity and for all-cause as well as cardiovascular death in both the general population and patients with cardiovascular disease. [1][2][3][4] In particular, recent studies have shown that any stage of renal dysfunction (mild to severe) is an independent risk factor for short-and long-term mortality among patients with myocardial infarction (MI), even after administration of fibrinolytics. [5][6][7][8] Moreover, it has been demonstrated that impaired renal function is associated with poorer clinical outcome after either percutaneous coronary intervention or coronary artery bypass graft surgery. [9][10][11][12] Several recently published studies have shown that renal insufficiency is common among patients with a broad spectrum of acute coronary syndromes (ACS) at admission and is associated with higher risk of death as well as major bleeding. [13][14][15][16][17][18][19] However, the effect of renal insufficiency in patients with non-ST-segment elevation MI (NSTEMI) and unstable angina (UA) has been less extensively investigated.The primary objective of this study was to evaluate the characteristics of patients with varying degrees of renal dysfunction among those hospitalized with all clinical presentations of ACS and the impact of renal dysfunction on in-hospital cardiovascular mortality of those patients. Secondarily, we sought to investigate the aforementioned for those with ST-segment elevation MI (STEMI) and those with NSTEMI and UA, separately and to compare the predictive value of these 2 final models in order to conclude in which of these 2 subgroups creatinine clearance is the better predictor. Methods DesignThe design and rationale of this study have been described in detail previously. 20 Briefly, from October 2003 to September 2004 (12 months) we enrolled almost all consecutive patients (participation rate =98%) that entered cardiology clinics or emergency units of 6 major general hospitals in Greece. Finally, the study included only those patients with a discharge diagnosis of ACS; that is, patients STEMI or NSTEMI and UA. The criteria for the diagnosis of STEMI, NSTEMI and UA took into account clinical presentation, ECG findings and the results of serum biochemical markers of necrosis. In particular, acute MI was defined by a typical rise and gradual fall of troponin or a more rapid rise and fall of creatine kinase (CK)-MB, with at least 1 of the following: (a) ischemic symptoms, (b) development of Background The relationship between renal dysfunction and mortality in patients with myocardial infarction (MI) has been extensively investigated, but there are limited data about this relationship in patients presenting with non-ST-segment-elevation MI and unstable angina. Therefore, the aim of the present study was to investigate whether renal insufficiency is an independent predictor for in-hospital mortality among such patients. Methods and ResultsTwo thousand a hundred and seventy-two patie...

Renal Insufficiency is Related to Painless Myocardial Infarction

“…In the present study, renal insufficiency was significantly correlated with Killip class ≥II (p=0.026). In addition, renal function decreases with age, 9 and in the present study age was identified by univariate analysis as a predictor of painless MI. However, multivariate analysis of the factors identified with univariate analysis, including age and Killip class ≥II, showed that only renal insufficiency was an independent predictor for painless MI (Table 4).…”

“…However, multivariate analysis of the factors identified with univariate analysis, including age and Killip class ≥II, showed that only renal insufficiency was an independent predictor for painless MI (Table 4). A recent study has shown that time from symptom onset to admission is longer in patients with renal insufficiency, 9 possibly because of a lack of painful symptoms.…”

Acute Complications of Hemodialysis

“…It was demonstrated in a study made by Komukai et al that as the renal function disorders increased, the prevalence of painless MI also increased (Komukai et al, 2007). In another study conducted by Pitsavos C et al, it was shown that MI patients with renal failure admitted to the hospital late and the possible reason for such late admission was thought to be the less occurence of alerting symptoms such as chest pain in this patient group (Pitsavos et al, 2007). Late admissions certainly mean that coronary interventions are less and mortality is more.…”

The Time Has Come for New, More Precise Guidelines in the Treatment of High-Risk Acute Coronary Syndromes With Heparin

“…Renal function per se did not influence the anticoagulation activity of UFH (Fig 5). The reported higher [18][19][20] risk of bleeding in patients with renal dysfunction treated with UFH is a consequence of the complex impairment of coagulation in those patients. 21 In accordance with this, we found a correlation between the level of serum creatinine and loss of hemoglobin (Fig 5).…”