Impact of Renal Insufficiency on Prognosis of Patients with Acute Coronary Syndrome

Abstract

Purpose

Chronic kidney disease (CKD) is common in patients admitted with acute coronary syndrome (ACS), and it is associated with poor outcomes. However, data are limited. Hence, we examined the long-term prognostic significance of estimated glomerular filtration rate (eGFR) among Chinese patients hospitalized with ACS.

Patients and Methods

This is a multicenter, observational study that included 1860 ACS patients enrolled between March 2014 and June 2019 from 11 hospitals in Chengdu. CKD-EPI equation was used to calculate the baseline eGFR. Patients were divided into three groups: eGFR ≥ 90 mL/min (normal renal function), eGFR 60 to <90 mL/min (mild impaired renal function), and eGFR < 60 mL/min (moderate or severe renal dysfunction). The endpoint was all-cause death during follow-up.

Results

At baseline, 714 patients had normal renal function, while 746 patients had mild impaired renal function, and 400 patients had moderate or severe renal dysfunction. In the follow-up of 15 months (10 months, 22 months), 261 (14.0%) patients died;, 139 (34.8%) in the moderate or severe renal dysfunction group, 94 (12.6%) in the mild impaired renal function group, and 28 (3.9%) in the normal renal function group (log-rank p-value from Kaplan–Meier analysis <0.001). In multivariable Cox Proportional hazard analysis, age, systolic blood pressure (SBP), heart rate, eGFR, ST-elevation myocardial infarction (STEMI), and percutaneous coronary intervention (PCI) were independent predictors of all-cause death.

Conclusion

In this study, among Chinese patients with ACS, renal insufficiency was associated with unfavorable long-term prognosis. Age, SBP, heart rate, eGFR, STEMI, and PCI could identify those at risk.

Keywords:

• renal insufficiency
• acute coronary syndrome
• long-term prognosis
• retrospective study

Data Sharing Statement

The datasets used are available from the corresponding authors on reasonable requests.

Ethics Approval and Consent to Participate

The study was conducted according to the guidelines of the Declaration of Helsinki. The study was approved by the ethics committee of The Third People’s Hospital of Chengdu. This study was an observational study and was a collection and research of previously archived data and documents, which were public resources. Through the data collected in this study, the subjects could not be sought out, and the research project did not involve personal privacy and commercial interests, which complied with the regulations of “Measures for ethical review of biomedical research involving human beings” issued by China in 2016 and the Declaration of Helsinki, therefore the Ethics Committee of the Third People’s Hospital of Chengdu approved the waiver for informed consent. Statement of patient data confidentiality: After completion of the data collection in our study, the personal information of identifiable subjects related to the data was deleted, and anonymous numbers were used to replace it. The data from our study were holistic rather than individual. In addition, the data of this study were collected and managed by trained professionals to avoid data leakage.

Acknowledgments

This study was supported by the Science and Technology Department of Sichuan, China [Grant number 2020YJ0483 and 2021YJ0215]. The authors would like to express their gratitude to EditSprings (https://www.editsprings.com/) for the expert linguistic services provided.

Disclosure

All authors declare that there is no conflict of interest.