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Outcomes of acute coronary syndrome in a large Canadian cohort: impact of chronic renal insufficiency, cardiac interventions, and anemia.
Am J Kidney Dis. 2005 Nov; 46(5):845-55.AJ

Abstract

BACKGROUND

Chronic renal insufficiency (CRI) has been identified as an important risk factor for cardiac events. Studies in the United States reported decreased survival and decreased use of surgical and medical interventions after myocardial infarction in patients with CRI.

METHODS

We studied the impact of renal function on health outcomes in a Canadian cohort of consecutive patients admitted with acute coronary syndrome (ACS) between October 1997 and October 1999. The study design is an observational cohort of 5,549 adult patients who survived to discharge with a discharge diagnosis of ACS. Renal function is classified into 4 levels: (1) normal, glomerular filtration rate (GFR) greater than 80 mL/min/1.73 m2 (>1.33 mL/s); (2) mild CRI, GFR of 60 to 80 mL/min/1.73 m2 (1.00 to 1.33 mL/s); (3) moderate CRI, GFR of 30 to 59 mL/min/1.73 m2 (0.50 to 0.98 mL/s); and (4) severe CRI, GFR less than 30 mL/min/1.73 m2 (<0.50 mL/s). The primary outcome is death.

RESULTS

Advanced and moderate CRI independently predicted death (hazard ratio, 1.06; 95% confidence interval [CI], 1.01 to 1.12; and hazard ratio, 1.23; 95% CI, 1.18 to 1.29). Severe anemia (hemoglobin level < 9.0 g/dL [<90 g/L]) also was an independent risk factor for death (hazard ratio, 1.38; 95% CI, 1.18 to 1.61). Use of beta-blockers (hazard ratio, 0.91; 95% CI, 0.86 to 0.97), acetylsalicylic acid (hazard ratio, 0.90; 95% CI, 0.84 to 0.97), lipid-lowering therapy (hazard ratio, 0.84; 95% CI, 0.78 to 0.89), and medical thrombolysis (hazard ratio, 0.89; 95% CI, 0.81 to 0.97) were associated with reduced risk for death. Medical interventions with beta-blockers, acetylsalicylic acid, lipid-lowering therapy, and thrombolysis and surgical intervention were significantly less likely to be used in patients with CRI.

CONCLUSION

Despite universal access to health care, Canadian patients with CRI are more likely to die after a cardiac event and less likely to receive important interventions.

Authors+Show Affiliations

Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. tammy.keough-ryan@cdha.nshealth.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16253724

Citation

Keough-Ryan, Tammy M., et al. "Outcomes of Acute Coronary Syndrome in a Large Canadian Cohort: Impact of Chronic Renal Insufficiency, Cardiac Interventions, and Anemia." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 46, no. 5, 2005, pp. 845-55.
Keough-Ryan TM, Kiberd BA, Dipchand CS, et al. Outcomes of acute coronary syndrome in a large Canadian cohort: impact of chronic renal insufficiency, cardiac interventions, and anemia. Am J Kidney Dis. 2005;46(5):845-55.
Keough-Ryan, T. M., Kiberd, B. A., Dipchand, C. S., Cox, J. L., Rose, C. L., Thompson, K. J., & Clase, C. M. (2005). Outcomes of acute coronary syndrome in a large Canadian cohort: impact of chronic renal insufficiency, cardiac interventions, and anemia. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 46(5), 845-55.
Keough-Ryan TM, et al. Outcomes of Acute Coronary Syndrome in a Large Canadian Cohort: Impact of Chronic Renal Insufficiency, Cardiac Interventions, and Anemia. Am J Kidney Dis. 2005;46(5):845-55. PubMed PMID: 16253724.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of acute coronary syndrome in a large Canadian cohort: impact of chronic renal insufficiency, cardiac interventions, and anemia. AU - Keough-Ryan,Tammy M, AU - Kiberd,Bryce A, AU - Dipchand,Christine S, AU - Cox,Jafna L, AU - Rose,Caren L, AU - Thompson,Kara J, AU - Clase,Catherine M, PY - 2005/03/31/received PY - 2005/07/19/accepted PY - 2005/10/29/pubmed PY - 2005/12/13/medline PY - 2005/10/29/entrez SP - 845 EP - 55 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. VL - 46 IS - 5 N2 - BACKGROUND: Chronic renal insufficiency (CRI) has been identified as an important risk factor for cardiac events. Studies in the United States reported decreased survival and decreased use of surgical and medical interventions after myocardial infarction in patients with CRI. METHODS: We studied the impact of renal function on health outcomes in a Canadian cohort of consecutive patients admitted with acute coronary syndrome (ACS) between October 1997 and October 1999. The study design is an observational cohort of 5,549 adult patients who survived to discharge with a discharge diagnosis of ACS. Renal function is classified into 4 levels: (1) normal, glomerular filtration rate (GFR) greater than 80 mL/min/1.73 m2 (>1.33 mL/s); (2) mild CRI, GFR of 60 to 80 mL/min/1.73 m2 (1.00 to 1.33 mL/s); (3) moderate CRI, GFR of 30 to 59 mL/min/1.73 m2 (0.50 to 0.98 mL/s); and (4) severe CRI, GFR less than 30 mL/min/1.73 m2 (<0.50 mL/s). The primary outcome is death. RESULTS: Advanced and moderate CRI independently predicted death (hazard ratio, 1.06; 95% confidence interval [CI], 1.01 to 1.12; and hazard ratio, 1.23; 95% CI, 1.18 to 1.29). Severe anemia (hemoglobin level < 9.0 g/dL [<90 g/L]) also was an independent risk factor for death (hazard ratio, 1.38; 95% CI, 1.18 to 1.61). Use of beta-blockers (hazard ratio, 0.91; 95% CI, 0.86 to 0.97), acetylsalicylic acid (hazard ratio, 0.90; 95% CI, 0.84 to 0.97), lipid-lowering therapy (hazard ratio, 0.84; 95% CI, 0.78 to 0.89), and medical thrombolysis (hazard ratio, 0.89; 95% CI, 0.81 to 0.97) were associated with reduced risk for death. Medical interventions with beta-blockers, acetylsalicylic acid, lipid-lowering therapy, and thrombolysis and surgical intervention were significantly less likely to be used in patients with CRI. CONCLUSION: Despite universal access to health care, Canadian patients with CRI are more likely to die after a cardiac event and less likely to receive important interventions. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/16253724/Outcomes_of_acute_coronary_syndrome_in_a_large_Canadian_cohort:_impact_of_chronic_renal_insufficiency_cardiac_interventions_and_anemia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(05)01054-1 DB - PRIME DP - Unbound Medicine ER -