Relation between renal function, presentation, use of therapies and in‐hospital complications in acute coronary syndrome: data from the SWEDEHEART register

Abstract

Sweden) Relation between renal function, presentation, use of therapies and in-hospital complications in acute coronary syndrome: data from the SWEDE-HEART register. J Intern Med 2010; 268: 40-49.Objective. To examine clinical characteristics, presenting symptoms, use of therapy and in-hospital complications in relation to renal function in patients with myocardial infarction (MI).Design. Observational study. Subjects. Consecutive MI patients with available creatinine (n = 57 477).Results. Glomerular filtration rate was estimated with the Modification of Diet in Renal Disease Study formula. With declining renal function patients were older, had more co-morbidities and more often used cardio-protective medication on admission. Compared to patients with normal renal function, fewer with renal failure presented with chest pain (90% vs. 67%, P < 0.001), Killip I (89% vs. 58%, P < 0.001) and ST-elevation myocardial infarction (STEMI) (41% vs. 22%, P < 0.001). In a logistic regression model lower renal function was independently associated with a less frequent use of anticoagulant and revascularization in non-ST-elevation MI. The likelihood of receiving reperfusion therapy for STEMI was similar in patients with normal-to-moderate renal dysfunction, but decreased in severe renal dysfunction or renal failure. Reperfusion therapy shifted from primary percutaneous coronary intervention in 71% of patients with normal renal function to fibrinolysis in 58% of those with renal failure. Renal function was associated with a higher rate of complications and an exponential increase in in-hospital mortality from 2.5% to 24.2% across the renal function groups.Conclusion. Renal insufficiency influences the presentation and reduces the likelihood of receiving treatment according to current guidelines. Short-term prognosis remains poor.

Renal function on admission affects both treatment strategy and long-term outcomes of patients with myocardial infarction (from the Polish Registry of Acute Coronary Syndromes)

“…Our analysis found that MI patients differ in their clinical and angiographic characteristics, depending on their IRF grade, consistent with the findings of other studies [5][6][7][8][12][13][14][15][16]. In patients with worse IRF, there is a greater percentage of predictors of poorer prognosis.…”

“…The populations of patients with particular IRF grades noted in our analysis are comparable with the data from the GRACE [5], ACS I/II [5], and SWEDEHEART [7] registries. The observed differences between the studies result from the adopted definitions of renal dysfunction and criteria use to select and stratify the analysed population.…”

“…In the randomised clinical trials that have included patients with MI and renal dysfunction, the percentage of patients with moderate or higher grade of IRF (eGFR < 60 mL/min/1.73 m 2 ) ranged from 13.8% to 45.7% [12][13][14][15][16][17][18], while in registries from the past five years it ranged from 28.9% to 42.9% [5][6][7][8]. The populations of patients with particular IRF grades noted in our analysis are comparable with the data from the GRACE [5], ACS I/II [5], and SWEDEHEART [7] registries.…”

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

“…Choć pacjentów z przewlekłą chorobą nerek (CKD) charakteryzuje gorsze rokowanie w NSTE-ACS niż osoby z prawidłową funkcją nerek, to rzadziej są oni poddawaniu leczeniu zgodnemu z medycyną opartą na faktach, obejmującemu leki przeciwzakrzepowe i wczesną strategię inwazyjną [446,447]. Rozpoznanie NSTE-ACS u pacjentów z CKD może być trudniejsze ze względu na często obserwowane, łagodnie podwyższone stężenie troponin sercowych i nieprawidłowości w EKG (np.…”

Cardiovascular Risk and Chronic Kidney Disease: Cardio-Nephroprotection Strategies

“…Пациенты с ОПП 1,12-1,27, p<0,001) и 6-месячной (ОР 1,16, 95% ДИ 1,11-1,22, p<0,001) смертности [70]. Пациенты с ОКС, имеющие нарушение функции почек, часто не получают адекватную терапию [71,72], что объясняется как отсутствием данных о клинических исследованиях в этой популяции, так и высоким риском осложнений, прежде всего кровотечений и дальней-шего ухудшения функции почек. Есть данные, что у больных ХБП часто развиваются кровотечения вслед-ствие передозировки антитромботических препаратов, дозы которых, при преимущественно почечном пути выведения, нуждаются в коррекции с учетом функцио-нального состояния почек (табл.…”