Impact of renal function on patients with acute coronary syndromes: 15,593 patient-years study

Figures & data

Table 1. Characteristics of the studied population with comparison of patients with STEMI and NSTEMI.

Parameter	General population (N = 2213)	NSTEMI (N = 1288)	STEMI (N = 925)	p
Age (years), mean, (SD)	65.8 (12.2)	66.9 (12.1)	64.3 (12.2)	<.001
Male, % (N)	65.2 (1442)	63.7 (821)	67.1 (621)	.097
BMI (kg/m^2), mean, (SD)	30.0 (24.8)	30.1 (26.0)	29.7 (22.9)	.687
Arterial hypertension, % (N)	72.0 (1595)	77.0 (989)	66.0 (606)	<.001
Diabetes mellitus type 2, % (N)	23.2 (513)	26.4 (340)	18.7 (173)	<.001
Atrial fibrillation, % (N)	18.0 (398)	17.8 (229)	18.3 (169)	.767
Chronic kidney disease, % (N)	24.1 (533)	26.2 (337)	21.2 (196)	.006
Serum creatinine concentration (mg/dl), mean, (SD)	1.0 (0.3)	1.0 (0.3)	1.0 (0.3)	.092
Serum creatinine concentration after 48 h (mg/dl), mean, (SD)	1.0 (0.6)	1.0 (0.4)	1.04 (0.5)	.18
CI - AKI, % (N)	4.5 (99)	4.1 (53)	5.0 (46)	<.001
eGFR ml/min/1.73 m², mean, (SD)	77.9 (21.3)	76.6 (21.5)	79.7 (20.8)	<.001
Patients with eGFR ≥90 ml/min/1.73 m², % (N)	33.5 (742)	32.4 (417)	35.1 (325)	.177
Patients with eGFR 60–89 ml/min/1.73 m², % (N)	45.1 (999)	44.0 (567)	46.7 (432)	.212
Patients with eGFR 45–59 ml/min/1.73 m², % (N)	12.6 (279)	14.1 (181)	10.6 (98)	.014
Patients with eGFR 30–44 ml/min/1.73 m², % (N)	5.9 (130)	6.5 (84)	5.0 (46)	.119
Patients with eGFR 15–29 ml/min/1.73 m², % (N)	2.5 (63)	3.0 (39)	2.6 (24)	.541
Hemoglobin level (g/dl), mean, (SD)	13.8 (1.6)	13.6 (1.6)	13.8 (1.7)	.016
Platelets count (×10^3/mm^3), mean, (SD)	225.6 (72.3)	222.0 (69.2)	230.7 (76.1)	.006
Serum uric acid concentration (mg/dl), mean, (SD)	5.9 (3.5)	6.1 (4.4)	5.8 (1.7)	.017
AspAT activity (IU/l), mean, (SD)	70.5 (119.9)	66.2 (123.5)	76.5 (114.5)	.049
ALAT activity (IU/l), mean, (SD)	44.6 (139.3)	39.8 (68.2)	51.1 (198.9)	.111
Cholesterol concentration (mg/dl), mean, (SD)	202.4 (49.2)	198.4 (48.9)	207.9 (48.9)	<.001
LDL concentration (mg/dl), mean, (SD)	134.1 (45.2)	129.7 (45.1)	140.1 (44.8)	<.001
HDL concentration (mg/dl), mean, (SD)	47.3 (13.3)	46.9 (13.6)	47.8 (12.9)	.155
Triglycerides concentration (mg/dl), mean, (SD)	119.4 (85.9)	122.7 (88.6)	114.8 (81.8)	.013
Fibrinogen concentration (mg/dl), mean, (SD)	431.6 (114.0)	434.5 (115.1)	427.6 (114.8)	.388
Death, % (N)	31.9 (705)	33.2 (428)	30.0 (277)	<.001

ALAT: alanine aminotransferase; AKI: contrast-induced acute kidney injury; AspAT: aspartate aminotransferase; BMI: body mass index; CI: eGFR: estimated glomerular filtration rate; HDL: high density lipoprotein; LDL: low density lipoprotein; NSTEMI: non-ST segment elevation myocardial infarction; STEMI: ST-segment elevation myocardial infarction.

Table 2. Comparison of patients with and without chronic kidney disease.

Parameter	Population with CKD (N = 533)	Population without CKD (N = 1680)	p
Age (years), mean, (SD)	75.3 (8.9)	62.8 (11.6)	<.001
Male, % (N)	50.1 (267)	69.9 (1175)	<.001
BMI (kg/m^2), mean, (SD)	29.1 (12.7)	30.2 (27.2)	.496
Arterial hypertension, % (N)	79.7 (425)	69.6 (1170)	<.001
Diabetes mellitus type 2, % (N)	40.7 (217)	17.6 (296)	<.001
Atrial fibrillation, % (N)	33.6 (179)	13.0 (219)	<.001
Serum creatinine concentration (mg/dl), mean, (SD)	1.4 (0.4)	0.9 (0.1)	<.001
Serum creatinine concentration after 48 h (mg/dl), mean, (SD)	1.5 (0.7)	0.9 (0.2)	<.001
CI–AKI, % (N)	8.4 (45)	3.2 (54)	<.001
Hemoglobin level (g/dl), mean, (SD)	12.9 (1.9)	13.9 (1.5)	<.001
Platelets account (×10^3/mm^3), mean, (SD)	223 (85.8)	226.5 (67.4)	.091
Serum uric acid concentration (mg/dl), mean, (SD)	7.4 (5.1)	5.5 (2.8)	<.001
AspAT activity (IU/l), mean, (SD)	88.1 (135.6)	65.1 (113.9)	<.001
ALAT activity (IU/l), mean, (SD)	53.9 (124.0)	41.6 (143.7)	.495
Total serum cholesterol concentration (mg/dl), mean, (SD)	188.3 (48.3)	206.7 (48.7)	<.001
Serum LDL cholesterol concentration (mg/dl), mean, (SD)	122.4 (43.2)	137.6 (45.3)	<.001
Serum HDL cholesterol concentration (mg/dl), mean, (SD)	44.7 (13.5)	48.1 (13.1)	<.001
Serum triglyceride concentration (mg/dl), mean, (SD)	115.7 (69.8)	120.5 (90.2)	.272
Fibrinogen concentration (mg/dl), mean, (SD)	463.2 (126.3)	421.8 (109.4)	<.001
Death, % (N)	56.3 (300)	24.1 (405)	<.001

ALAT: alanine aminotransferase; AspAT: aspartate aminotransferase; BMI: body mass index; CKD: chronic kidney disease; CI–AKI, contrast-induced acute kidney injury; HDL: high density lipoprotein; LDL: low density lipoprotein.

Table 3. Comparison of patients with and without contrast-induced acute kidney injury.

Parameter	Population with PC–AKI (N = 99)	Population without PC–AKI (N = 2114)	p
Age (years), mean, (SD)	71.1 (11.1)	65.6 (12.2)	<.001
Male, % (N)	65.7 (65)	65.1 (1377)	.920
BMI (kg/m2), mean, (SD)	28.9 (5.0)	28.2 (4.8)	.240
Arterial hypertension, % (N)	72.7 (72)	72.00 (1523)	.880
Diabetes mellitus type 2, % (N)	38.4 (38)	22.5 (475)	.002
Atrial fibrillation, % (N)	35.4 (35)	17.2 (363)	<.001
Chronic kidney disease, % (N)	45.5 (45)	23.1 (488)	<.001
Serum creatinine concentration (mg/dl), mean, (SD)	1.2 (0.6)	1.00 (0.3)	<.001
eGFR ml/min/1.73 m², mean, (SD)	65.0 (25.7)	78.5 (20.8)	<.001
Patients with eGFR ≥90 ml/min/1.73 m², % (N)	20.2 (20)	34.2 (722)	<.001
Patients with eGFR 60–89 ml/min/1.73 m², % (N)	39.4 (39)	45.4 (960)	.230
Patients with eGFR 45–59 ml/min/1.73 m², % (N)	15.2 (15)	12.5 (264)	.460
Patients with eGFR 30–44 ml/min/1.73 m², % (N)	11.1 (11)	5.6 (119)	.090
Patients with eGFR 15–29 ml/min/1.73 m², % (N)	14.1 (14)	2.3 (49)	<.001
Hemoglobin level (g/dl), mean, (SD)	13.1 (2.2)	13.7 (1.6)	.004
Platelets account (×10^3/mm3), mean, (SD)	217.3 (79)	226 (71.9)	.280
Serum uric acid concentration (mg/dl), mean, (SD)	6.6 (2.4)	5.9 (3.6)	.020
AspAT activity (IU/l), mean, (SD)	172.5 (375.1)	65.7 (88.9)	.007
ALAT activity (IU/l), mean, (SD)	104 (270.7)	41.6 (128.7)	.030
Total serum cholesterol concentration (mg/dl), mean, (SD)	193.6 (51.2)	202.8 (49.1)	.090
Serum LDL cholesterol concentration (mg/dl), mean, (SD)	128.5 (46.1)	134.3 (45.2)	.230
Serum HDL cholesterol concentration (mg/dl), mean, (SD)	47.3 (14.1)	47.3 (13.3)	.880
Serum triglyceride concentration (mg/dl), mean, (SD)	106.2 (57.2)	120.01 (87)	.03
Fibrinogen concentration (mg/dl), mean, (SD)	453.4 (130.3)	430.6 (114.1)	.10
Death, % (N)	57.6 (57)	30.7 (648)	<.001

ALAT: alanine aminotransferase; AspAT: aspartate aminotransferase; BMI: body mass index; CKD: chronic kidney disease; eGFR: estimated glomerular filtration rate; HDL: high-density lipoprotein; LDL: low-density lipoprotein; PC–AKI: post-contrast acute kidney injury.

Table 4. Comparison of dead and alive patients.

Parameter	Dead (N = 705)	Alive (N = 1508)	p
Age (years), mean, (SD)	72.4 (10.8)	62.7 (11.6)	<.001
Male, % (N)	62.6 (441)	66.4 (1001)	.081
BMI (kg/m^2), mean, (SD)	31.7 (37.7)	29.2 (17.1)	.159
NSTEMI, % (N)	60.7 (428)	57.0 (860)	.101
STEMI, % (N)	39.3 (277)	43.0 (648)	.101
Arterial hypertension, % (N)	74.9 (528)	70.8 (1067)	.040
Diabetes mellitus type 2, % (N)	32.2 (227)	19.0 (286)	<.001
Atrial fibrillation, % (N)	28.9 (204)	12.9 (194)	<.001
Chronic kidney disease, % (N)	42.6 (300)	15.5 (233)	<.001
Serum creatinine concentration (mg/dl), mean, (SD)	1.1 (0.4)	0.9 (0.3)	<.001
Serum creatinine concentration after 48 hours (mg/dl), mean, (SD)	1.2 (0.6)	1.0 (0.3)	<.001
PC- AKI, % (N)	8.1 (57)	2.78 (42)	<.001
eGFR ml/min/1.73 m², mean, (SD)	67.1 (22.6)	82.9 (18.5)	<.001
Patients with eGFR ≥90 ml/min/1.73 m², % (N)	16.6 (117)	41.4 (625)	<.001
Patients with eGFR 60–89 ml/min/1.73 m², % (N)	44.8 (316)	45.3 (683)	.836
Patients with eGFR 45–59 ml/min/1.73 m², % (N)	19.7 (139)	9.3 (140)	<.001
Patients with eGFR 30–44 ml/min/1.73 m², % (N)	12.1 (85)	3.0 (45)	<.001
Patients with eGFR 15–29 ml/min/1.73 m², % (N)	6.8 (48)	1.0 (15)	<.001
Hemoglobin level (g/dl), mean, (SD)	13.1 (1.9)	14.0 (1.4)	.016
Platelets count (×10^3/mm^3), mean, (SD)	226.8 (89.5)	225.1 (62.6)	.006
Serum uric acid concentration (mg/dl), mean, (SD)	6.4 (2.3)	5.7 (3.9)	.017
AspAT activity (IU/l), mean, (SD)	93.8 (179.4)	59.5 (74.6)	.049
ALAT activity (IU/l), mean, (SD)	51.2 (95.8)	41.5 (155.2)	.111
Cholesterol concentration (mg/dl), mean, (SD)	192.0 (49.2)	207.1 (48.5)	<.001
LDL concentration (mg/dl), mean, (SD)	125.8 (44.7)	137.8 (45.0)	<.001
HDL concentration (mg/dl), mean, (SD)	45.1 (13.2)	48.2 (13.2)	.155
Triglycerides concentration (mg/dl), mean, (SD)	113.5 (73.6)	122.1 (90.8)	.013
Fibrinogen concentration (mg/dl), mean, (SD)	465.3 (130)	416.2 (104)	.388

ALAT: alanine aminotransferase; AspAT: aspartate aminotransferase; BMI: body mass index; eGFR: estimated glomerular filtration rate; HDL: high-density lipoprotein; LDL: low-density lipoprotein; NSTEMI: non-ST segment elevation myocardial infarction; PC–AKI: post-contrast acute kidney injury; STEMI: ST-segment elevation myocardial infarction.

Table 5. Spearman’s correlation rank between eGFR change rate and biochemical results.

Variables	All patients	NSTEMI	STEMI
eGFR using CKD-EPI	−0.2	−0.2	−0.2
Hemoglobin	0.01	0.01	0.02
PLT	−0.04	0.01	−0.12
Uric acid	−0.01	−0.01	−0.01
AspAT	0.11	0.04	0.14
ALAT	0.05	−0.02	0.08
Total cholesterol	0.03	0.04	−0.01
LDL	0.04	0.05	0.01
HDL	0.02	0.02	−0.01
Triglycerides	−0.02	−0.04	−0.01
Fibrinogen	0.01	0.01	−0.01

ALAT: alanine aminotransferase; AspAT: aspartate aminotransferase; eGFR: estimated glomerular filtration rate; HDL: high-density lipoprotein; LDL: low-density lipoprotein; PLT: platelets count.

The bold values represents as statistically significant p<.001 values.

Table 6. Multivariable logistic regression forward stepwise Wald method – risk ratio for risk of post-contrast acute kidney injury.

	p	RR	CI for RR (95%)
Creatinine concentration (for an increase of 1 mg/dl)	<.001	2.99	1.567 − 5.721
Diabetes mellitus	.042	2.143	1.029 − 4.463
Atrial fibrillation	.036	2.289	1.056 − 4.959

R² Nagelkerke = 0.369.

Table 7. Multivariable logistic regression forward stepwise Wald method –risk ratio for risk of death – all population.

	p	RR	CI for RR (95%)
Male	.002	1.503	1.156 − 1.955
Age (for an increase of 1 year)	<.001	1.060	1.048 − 1.072
Postprocedural creatinine concentration (for an increase of 1 mg/dl)	<.001	2.254	1.481 − 3.424
Diabetes mellitus	.004	1.512	1.145 − 1.977
Atrial fibrillation	.034	1.695	1.251 − 2.297
Hemoglobin concentration (for an increase of 1 g/dl)	.007	0.895	0.826 − 0.970
Fibrinogen concentration (for an increase of 10 mg/dl)	<.001	1.028	1.018 − 1.068

R² Nagelkerke = 0.469.

Table 8. Multivariable logistic regression forward stepwise Wald method – risk of death in NSTEMI population.

	p	RR	CI for RR (95%)
Age (for an increase of 1 year)	.008	1.067	1.052 − 1.083
Postprocedural creatinine concentration (for an increase of 1 mg/dl)	<.001	2.542	1.281 − 3.124.
Atrial fibrillation	.010	1.689	1.132 − 2.520
Hemoglobin concentration (for an increase of 1 g/dl)	.025	0.887	0.787 − 0.986
Fibrinogen concertation (for an increase of 10 mg/dl)	<.001	1.026	1.012 − 1.040

R² Nagelkerke = 0.443.

Table 9. Multivariable logistic regression forward stepwise Wald method – risk of death in STEMI population.

	p	RR	CI for RR (95%)
Male sex	.007	1.787	1.176 − 2.716
Age (for an increase of 1 year)	<.001	1.047	1.029 − 1.066
BMI (for an increase of 1 kg/m^2)	.031	0.961	0.926 − 0.998
Diabetes mellitus	<.001	2.150	1.373 − 3.369
Atrial Fibrillation	.012	1.847	1.143 − 2.986
Hemoglobin concentration (for an increase of 1 g/dl)	.047	0.883	0.781 − 0.998
Fibrinogen concentration (for an increase of 10 mg/dl)	<.001	1.032	1.015 − 1.049

R² Nagelkerke = 0.495.

Figure 1. Selection of study population.