Background
Preexisting renal insufficiency is a strong predictor of cardiovascular mortality and morbidity in patients admitted with acute coronary syndrome. The prognostic significance of worsening renal function has also been shown in various cohorts of cardiac diseas. However, the thirty-day prognostic importance of worsening renal function in the patients with non-ST elevation myocardial infarction (NSTE-MI) is not well documented.
Methods
We prospectively analyzed 387 consecutive patients with NSTE-MI. Worsening renal function was defined as a 25% or more decrease in estimated GFR (eGFR) during of hospitalization period. We have categorized the patients in two groups; worsening and without worsening group. Baseline demographics, clinical feature, angiographic findings, receival of invasive treatment, and thirty day mortality were compared. Additionally, we performed multivariate analysis for thirty day mortality.
Methods
We prospectively analyzed 387 consecutive patients with NSTE-MI. Worsening renal function was defined as a 25% or more decrease in estimated GFR (eGFR) during of hospitalization period. We have categorized the patients in two groups; worsening and without worsening group. Baseline demographics, clinical feature, angiographic findings, receival of invasive treatment, and thirty day mortality were compared. Additionally, we performed multivariate analysis for thirty day mortality.
Results
Mean age of patients were 63±13 years (67%, male). Worsening renal function ocuured in 47 (12%) patients, who were older and had more cerebrovascular disease (67±12 vs 63±13, p=0.032 and 15% vs 7%, p=0.40). But other risc factors of coronary artery diseas were similar among the two groups. The percentage of patinents with high GRACE scores (>140) were 53% in the worsening group versus 34% in the without worsening group (p=0.012). Mean value of baseline eGFR was lower in the worsening group (65±26 vs 76±24 ml/min./1.73m2, p=0.001). Patients with worsening renal function were more often of multi vessels disease (three vessels disease 27% vs 19%, p=0.021). Thirty-day all cause mortality rates were 17% in the worsening group versus 4.1% in the without worsening group (p<0.0001). Worsening renal function was identified as an independent predictor of thirty-day mortality after multivariate analysis including significant variables in univariate analysis ( odds ratio=3.395, 95% CI 1.257-9.175, p=0.016).
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