The prognostic impact of in-hospital worsening of renal function in patients with
acute coronary syndrome
AlFaleh, HF [ 1 ]; Alsuwaida, AO [ 2 ]; Ullah, A [ 3 ]; Hersi, A [ 1 ]; AlHabib, KF [ 1 ]; AlNemer, K
[ 3 ]; AlSaif, S [ 4 ]; Taraben, A [ 5 ]; Kashour, T [ 6 ]; Balghith, MA [ 7 ]; Ahmed, WH [ 8 ]
INTERNATIONAL JOURNAL OF CARDIOLOGY
Volume: 167, Issue: 3, Pages: 866-870, DOI: 10.1016/j.ijcard.2012.01.097, Published:
AUG 10 2013
Publisher ELSEVIER IRELAND LTD, ELSEVIER HOUSE, BROOKVALE PLAZA, EAST
PARK SHANNON, CO, CLARE, 00000, IRELAND
ISSN: 0167-5273
Abstract
Background: Renal impairment is strongly linked to adverse cardiovascular (CV) events.
Baseline renal dysfunction is a strong predictor of CV mortality and morbidity in patients
admitted with acute coronary syndrome (ACS). However, the prognostic importance of
worsening renal function (WRF) in these patients is not well characterized.
Methods: ACS patients enrolled in the SPACE (Saudi Project for Assessment of Coronary
Events) registry who had baseline and pre-discharge serum creatinine data available
were eligible for this study. WRF was defined as a 25% reduction from admission
estimated glomerular filtration rate (eGFR) within 7 days of hospitalization. Baseline
demographics, clinical presentation, therapies, and in-hospital outcomes were compared.
Results: Of the 3583 ACS patients, WRF occurred in 225 patients (6.3%), who were
older, had more cardiovascular risk factors, were more likely to be female, have past
vascular disease, and presented with more non-ST-segment elevation myocardial
infarction than patients without WRF (39.5% vs. 32.8%; p = 0.042). WRF was associated
with an increased risk of in-hospital death, heart failure, cardiogenic shock, and stroke.
After adjusting for potential confounders, WRF was an independent predictor of
in-hospital death (adjusted odd ratio 28.02, 95% CI 13.2-60.28, p<0.0001). WRF was
more predictive of mortality than baseline eGFR.
Conclusion: These results indicate that WRF is a powerful predictor for in-hospital
mortality and CV complications in ACS patients. (C) 2012 Elsevier Ireland Ltd. All rights
reserved.
Keywords
Author Keywords:Acute coronary syndrome; Worsening renal function; Cardiovascular
outcomes
KeyWords Plus:ACUTE MYOCARDIAL-INFARCTION;
GLOMERULAR-FILTRATION-RATE; CHRONIC KIDNEY-DISEASE; CREATININE
CLEARANCE; CARDIOVASCULAR-DISEASE; OUTCOMES; MORTALITY; REGISTRY;
INSUFFICIENCY; ASSOCIATION
Author Information
Reprint Address: AlFaleh, HF E-mail Addresses:halfaleh@ksu.edu.sa
King Saud Univ, Coll Med, POB 7805, Riyadh 11472, Saudi Arabia.
Organization-Enhanced Name(s)
King Saud University
Addresses:
[ 1 ] King Saud Univ, Cardiac Sci Dept, Coll Med, King Khalid Univ Hosp, Riyadh 11472,
Saudi Arabia
Organization-Enhanced Name(s)
King Khalid University Hospital
King Saud University
[ 2 ] King Saud Univ, Dept Med, Coll Med, King Khalid Univ Hosp, Riyadh 11472, Saudi
Arabia
Organization-Enhanced Name(s)
King Khalid University Hospital
King Saud University
[ 3 ] Secur Forces Hosp, Dept Med, Riyadh, Saudi Arabia
Organization-Enhanced Name(s)
Security Forces Hospital - Saudi Arabia
[ 4 ] Saud AlBabtain Cardiac Ctr, Dammam, Saudi Arabia
[ 5 ] King Faisal Specialist Hosp & Res Ctr, Jeddah, Saudi Arabia
Organization-Enhanced Name(s)
King Faisal Specialist Hospital & Research Center
King Faisal Specialist Hospital & Research Center - Jeddah
[ 6 ] King Fahd Med City, Prince Salman Heart Ctr, Riyadh, Saudi Arabia
Organization-Enhanced Name(s)
King Fahad Medical City
[ 7 ] King Abdul Aziz Med City, Cardiac Ctr, Natl Guard, Riyadh, Saudi Arabia
Organization-Enhanced Name(s)
King Abdulaziz Medical City
National Guard Health Affairs - Saudi Arabia
King Abdulaziz Medical City - Riyadh
[ 8 ] King Fahd Armed Forces Hosp, Jeddah, Saudi Arabia
Organization-Enhanced Name(s)
King Fahd Armed Forces Hospital