Abstracts

Abstract

Purpose: Acute renal dysfunction has an unquestionable negative impact on prognosis of patients (P) with acute coronary syndromes (ACS). The purpose of this study was to determine the prevalence of cardiorenal syndrome (CRS) in P with ACS, its predictors and prognostic importance. Methods: Prospective study of 128P (62.5% male, age 68.7±13.1 years), admitted for ACS to a Coronary Unit, between June and November 2009. CRS was defined as an increase in serum creatinine ≥26.5umol/L. Demographic, clinical and analytical parameters; development of new heart failure (HF); severity of coronary artery disease (CAD) and in-hospital mortality (IHmort) were compared. Results: CRS occurred in 29 P (22.7%). The factors at admission associated with CRS were: older ages (76.6±8.5 vs 66.1±13.4; p <0.001), higher levels of BUN (11.4±5.9 vs 7.8±4.9; p<0.001), creatinine (151.4± 118.8 vs 94.8±69.4; p<0.001), cystatin-C (Cys-C) (1.75±0.8 vs 0.89±0.4; p<0.001), uric acid (471±154 vs 346±105; p<0.001) and NT-pro-BNP (13420±11865 vs 2472±4115); lower glomerular filtration rate (GFR, calculated with MDRD) (45.3±15.6 vs 74.6±23.8; p <0.001), sodium (135.7±4.6 vs 139±3.7; p < 0.001) and haemoglobin (12.3±2.1 vs 13.8±1.8; p <0.001) and chronic renal failure (48.3% vs 8.1%; p <0.001). No association was found between CRS and sex, diabetes, hypertension; blood pressure at admission and troponin. In multivariate analysis Cys-C was the best predictor of CRS. Among P who developed CRS 34.5% had normal creatinine and 17.2% normal GFR although high Cys-C (OR 30.9; p < 0.001). In this study, Cys-C had high sensitivity (92.9%) and negative predictive value (97.2%). P who developed CRS were treated with higher daily doses of intravenous (iv) furosemide (p < 0.001); required more often iv inotropes (p < 0.001), intra-aortic balloon pump (p = 0.008) and renal replacement therapy (p = 0.011). Those P had higher GRACE risk score (252±69 vs 188±53; p < 0.001); longer hospitalizations (8.0±4.9 vs 5.3±4.1, p < 0.001); higher incidence of acute HF (KK≥2; 55.2% vs 18.2%; p< 0.001); more extensive CAD (number of vessels and segments evolved); more frequently were discharged with the diagnosis of new HF (37.5% vs 18.4%; p = 0.043) and had higher IHmort (24% vs 1%; p < 0.001). Conclusions: Worsening renal function is common in ACS patients and has a negative impact on prognosis. In this study, Cys-C is the parameter at admission that best predicts cardiorenal syndrome.