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The reduction of the glomerular filtration rate and the presence of microalbuminuria at the moment of admittance reduce the prognostics of patients with an acute coronary syndrome
Critical Care volume 11, Article number: P247 (2007)
Determination of the glomerular filtration rate (GFR) in patients with an acute coronary syndrome (ACS) has an important prognostic value. The presence of microalbuminuria (MA) is a known risk factor in patients with hypertension and diabetes. We know less about the effect of reduction of the GFR on patients with an ACS.
Four hundred and twenty-eight patients with an ACS, admitted to our coronary care unit (CCU), were studied prospectively. Sixty-three percent presented a non-ST-segment elevation myocardial infarction and 37% a ST-segment elevation myocardial infarction. During their hospitalization we registered cardiovascular risk factors; we determined the presence of MA (>3 mg/dl) in a 24-hour urine sample. We also took blood samples during the first 24 hours of their admittance to the CCU for a complete hemogram, levels of total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, creatinine, creatinine clearance (Cockroft-Gault equation), glucose, HbAc1, high-sensibility C-reactive protein and a follow-up of levels of Troponin, CK and CK-MB.
Thirty-nine percent of the patients with an ACS presented a GFR less than 60 ml/minute, and 36% presented MA at the moment of admittance to the CCU. Forty-four percent of the patients with a GFR less than 60 ml/minute also presented MA; on the contrary, only 32% of the patients with a GFR more than 60 ml/minute did so (P = 0.01). This group contains significantly more women (P = 0.001), more history of ischemic brain events and peripheral artery disease (P = 0.03), worse Killip score at the moment of admittance (P = 0.001), more development of cardiac insufficiency (P = 0.003) and a higher mortality during hospital stay (P = 0.03).
The intrahospital survival of patients with GFR less than 60 ml/minute and MA was 79%, to 96% in patients without MA and a GFR more than 60 ml/minute (P = 0.01; Log-rank test = 6). Patients with a GFR less than 60 ml/minute but without MA presented an intrahospital survival of 85%. In the multivariant analysis a GFR less than 60 ml/minute (OR = 2.0; 95% CI 1.13–3.53) and the presence of MA (OR = 2.30; 95% CI 1.37–3.86) were independent predictive factors of cardiac insufficiency and mortality.
The presence of a GFR less than 60 ml/minute and MA at the moment of admittance of a patient with an ACS identifies a group of patients with a bad prognosis. Future studies can reveal whether an improvement of the renal function can be beneficial for this group of patients.
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Lago, A.L., Acuña, J.G., Lange, S.D. et al. The reduction of the glomerular filtration rate and the presence of microalbuminuria at the moment of admittance reduce the prognostics of patients with an acute coronary syndrome. Crit Care 11, P247 (2007). https://0-doi-org.brum.beds.ac.uk/10.1186/cc5407
- Glomerular Filtration Rate
- Acute Coronary Syndrome
- Ischemic Brain
- Peripheral Artery