PURPOSE: To compare independent predictors of 1-year mortality after ACS in patients with and without renal dysfunction.
METHODS: Propspective observational study of 927 ACS patients; 1-year follow-up. Patients were divided in 2 groups according to creatinine clearance (CrCl): A (n=381) –CrCl < 60 ml/min and B (n=546) –CrCl ≥ 60 ml/min.
RESULTS: Group A patients were older (75.0±9.0 vs 61.0±12.0 p<0.001), more likely to be women and presented to hospital with more comorbidities (previous myocardial infartion, stroke, peripheral arterial disease and known heart failure, hypertension, diabetes and atrial fibrillation) than those with normal renal function. Regarding the extent of coronary disease, group A showed more frequently left main and three-vessels disease (7.7 vs 2.1%, p<0.01 and 24.7 vs 16.6%, p<0.05, respectively). These patients were less frequently submitted to an invasive strategy (43.4 vs 71.2%, p<0.001). Incidence of MACE and overall mortality during the 1-year follow-up were significantly higher in group A. On multivariate analysis we identified age ≥71, peak troponin I ≥25.2 UI/l, glycaemia on admission ≥152.5 mg/dl, left ventricular ejection fraction ≤;47.5%, Killip class >1, previous myocardial infarction and left bundle branch block as independent predictors of 1-year mortality in group B. In renal dysfunction patients the only independent predictors of mortality were age ≥74 and heart rate ≥78.5 bpm.
CONCLUSION: Renal dysfunction seems to be a so strong independent predictor of adverse outcome that masks the other traditional predictors of mortality after an ACS. These results suggest that in presence of renal dysfunction we need no more risk factors to aggressively treat these patients.
CLINICAL IMPLICATIONS: Renal dysfunction is an independent predictor of mortality in acute coronary syndromes (ACS). Presently, it is unknown if predictors of adverse outcome after an ACS are the same in patients with renal dysfunction as for general population.
DISCLOSURE: Natalia Antonio, None.