Effect Of Renal Dysfunction On Treatment And Prognosis In Patients With Acute Coronary Syndrome During The Hospital

Background:Chronic kidney disease is becoming common among patients with acute coronary syndromes (ACS). Patients with ACS who simultaneously suffer from renal dysfunction may have a poorer prognosis. Recent studies both at home and abroad have shown that creatinine clearance rate (Ccr) in patients with ACS play an important role in the prediction of early complications and prognosis. In most clinical trials renal dysfunction (generally measured by the level of plasma creatinine) has consistently been one of the exclusion criteria and therefore physicians may not have definitive evidence to support treatment decisions in clinical practice. There is still little information about the clinical features, management and prognosis of these patients and the causes and mechanism remains unclear.Purposes:To identify the differences in clinical characteristics of ACS patients associated with renal dysfunction; to evaluate whether the severity of renal dysfunction is related to the risk of adverse in-hospital outcomes and to the use of evidence-based therapies using the estimated Ccr.Methods:A retrospective study was carried out in patients with ACS hospitalized in the department of Cardiology of Qilu hospital between October 1,2008 and October 1, 2009. Baseline serum creatinine was available and creatinine clearance rates were estimated by the Cockcroft-Gault formula. Patients were stratified into three groups according to their creatinine clearance rates:group A (moderate and severe renal dysfunction, n=40):patients with a Ccr≤60 ml·min-1; group B (mild renal dysfunction, n=129):patients with Ccr<90 ml·min-1 and>60 ml·min-1; group C (normal renal function, n=101):patients with Ccr≥90 ml·min-1. Then the clinical characteristics, medication and adverse outcomes were compared with each other among three groups.Results:The patients with moderate and severe renal dysfunction presented the following differentiating characteristics:elderly, more smokers, longer days of hospitalization, higher grades of killip classification, predominantly female, higher blood pressure, as well as lower haemoglobin levels, higher density cholesterol and body mass index.The average level of Ccr trends to be increased with the increased number of narrowed coronary artery. There was a negative correlation (r=-0.0296,p=0.029) between the Gensini score which reflected the severity of coronary artery stenosis and the level of Ccr.Compared with group C, ACE inhibitors/angiotensin receptor blockers and Statins were used less extensively among patients in group A and group B. Moreover, Patients were less frequently underwent percutaneous coronary intervention in both group A and B. There were no significant differences in the usage of other medications.The incidence of recurrent angina pectoris, heart failure were higher in group A and B than those in group C. Though there were no significant differences in bleeding and in-hospital mortality among three groups, there were 7 patients occurred bleeding in group A and B, which was much more than that in group C.Conclusions:1. Renal dysfunction is clinically very common among patients with ACS and multi-cardiovascular risk factors incline to converge in these patients. These patients often have complex clinical conditions and severe lesion of coronary artery.2. There are less patients undergo guideline-recommended drug therapy and percutaneous coronary intervention as the renal dysfunction increased. More individual and aggressive treatment should be taken for these patients.3. With increased renal dysfunction, more cardiovascular events and poor prognosis were occurred in these patients.4. The measurement of Ccr should be considered as one of the factors in the early risk stratification in patients of ACS.