The Correlation Of Renal Insufficiency And Heart Failure And Its Prognostic Significance In Patients With Acute Coronary Syndrome

ObjectiveTo investigate the cardiac and renal function status in patients with acute coronary syndrome in Henan province,analyze the relationship of renal insufficiency(RI)and heart failure(HF)in acute coronary syndrome(ACS)patients,and explore the diagnosis and prognosis role of RI in HF patients stratified by left ventricular ejection fraction(LVEF).MethodsThis study is a multi-center,observational,prospective study,a total of 2014cases of ACS patients who met the standards were continuously collected from 7hospitals in Henan province.Baseline data(including demographic data,laboratory examination,physical examination,auxiliary examination and previous medical history,etc.)and adverse events during hospitalization were collected by the method of case report form,and data were double-input by Epidata software.Chi-square test,T test and Pearson test and logistic regression analysis was used to analyze data.According to the purpose of this study and the definition of the previous guidelines,the following criteria were grouped:HF with reduced ejection fraction(HFrEF),HF with mid-range ejection fraction(HFmrEF)and HF with preserved ejection fraction(HFpEF)were defined as LVEF<40%,40-49%and≥50%.RI was defined as estimated glomerular filtration rate(eGFR)<60 mL/min/1.73 m~2,and renal function is categorized as normal renal function,mild RI,moderate RI and severe RI with the eGFR>90,60-90,30-60 and<30 ml/min/1.73 m~2.ResultsAmong the enrolled ACS patients,totally 757 patients had HF,and 192(9.53%)had HFrEF,231(11.47%)had HFmrEF and 334(16.58%)had HFpEF.In patients with ACS and HF,373 patients(49.27%)had normal renal function,165 patients(21.80%)had mild RI and 219 patients(28.93%)had moderate or severe RI.About the in-hospital outcomes in the ACS population,the mean length of stay(LOS)was8.97±6.14 days,absolute rate of in-hospital mortality was 1.09%(22/2014),the rate of MACE happening was 3.23%(65/2014),and the adverse in-hospital outcomes occurred in 9.29%(187/2014)patients.Baseline data analysis showed no significant difference in eGFR levels(mL/min/1.73 m~2)between HFrEF,HFmrEF and HFpEF groups(76.02±29.69,78.24±30.69 and 80.61±32.34,P=0.257).N-terminal Pro-B-Type natriuretic peptide(NT-proBNP)levels were lower in HFpEF patients(1540[1088-3137]pg/mL),and there was no significant difference in NT-proBNP levels between HFrEF and HFmrEF patients(2430[1210-6088]pg/mL and1886[655-7890]pg/mL,P=0.640).The relationship of renal function and heart function in ACS patients were analyzed by T test,Pearson test and chi-square test,and the results showed that prevalence of RI(34.90%,30.30%and 24.55%)and severe RI(9.38%,10.82%and12.57%)were different in HFrEF,HFmrEF and HFpEF groups.Log NT-proBNP(r=-0.211)and LVEF(r=0.113)levels were correlated with eGFR level in ACS patients.However,there were no correlate between eGFR and BNP levels in HF patients.To analysis the predictive and prognostic significance of RI in HFrEF,HFmrEF and HFpEF patients by multivariate logistic,and analysis the odds ratios(OR)and95%confidence interval(95%CI),the results showed RI was confirmed to be a predictor for occurrence of HFrEF(OR,3.148;95%CI 1.935-5.123,P=0.000),HFmrEF(OR,1.678;95%CI 1.133-2.485,P=0.010)and HFpEF(OR,1.402;95%CI1.020-1.927,P=0.037)in ACS patients.RI was an independent risk factors for in-hospital adverse events of HFrEF patient(OR,3.107;95%CI 1.051-9.185,P=0.040),HFmrEF patients(OR,3.376;95%CI 1.440-7.915,P=0.005)and HFpEF patients(OR,3.635;95%CI 1.647-8.021,P=0.001),respectively.ConclusionRI and HF were closely related in ACS patients.RI could predict not only the occurrence but also adverse in-hospital events for HFpEF,HFmrEF and HFrEF patients.