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In-hospital major clinical outcomes in patients with chronic renal insufficiency presenting with acute coronary syndrome: data from a Registry of 8176 patients.
Mayo Clin Proc. 2010 Apr; 85(4):332-40.MC

Abstract

OBJECTIVE

To assess the impact of chronic renal insufficiency (CRI) on in-hospital major adverse cardiac events across the acute coronary syndrome (ACS) spectrum.

PATIENTS AND METHODS

From January 29, 2007, through July 29, 2007, 6 adjacent Middle Eastern countries participated in the Gulf Registry of Acute Coronary Events, a prospective, observational registry of 8176 patients. Patients were categorized according to estimated glomerular filtration rate into 4 groups: normal (>or=90 mL/min), mild (60-89 mL/min), moderate (30-59 mL/min), and severe CRI (<30 mL/min). Patients' characteristics and in-hospital major adverse cardiac events in the 4 groups were analyzed.

RESULTS

Of 6518 consecutive patients with ACS, 2828 (43%) had mild CRI, 1304 (20%) had moderate CRI, and 345 (5%) had severe CRI. In CRI groups, patients were older and had a higher prevalence of hypertension, diabetes mellitus, and dyslipidemia. On admission, these patients had a higher resting heart rate and frequently had atypical and delayed presentations. Compared with the normal estimated glomerular filtration group, CRI groups were less likely to receive antiplatelet drugs, beta-blockers, angiotensin-converting enzyme inhibitors, and statins and were less likely to undergo coronary angiography. In-hospital heart failure, cardiogenic shock, and major bleeding episodes were significantly higher in all CRI groups. In multivariate analysis, mild, moderate, and severe CRI were associated with a higher adjusted odds ratio (OR) of death (mild: OR, 2.1; 95% confidence interval [CI], 1.2-3.7; moderate: OR, 6.7; 95% CI, 3.9-11.5; and severe: OR, 12.0; 95% CI, 6.6-21.7).

CONCLUSION

Across the ACS spectrum, patients with CRI had a worse risk profile, had more atypical and delayed presentations, and were less likely to receive evidence-based therapy. Chronic renal insufficiency of varying stages is an independent predictor of in-hospital morbidity and mortality.

Authors+Show Affiliations

Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital, Doha, Qatar.No affiliation info availableNo affiliation info availableNo affiliation info availableNo 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

20360292

Citation

El-Menyar, Ayman, et al. "In-hospital Major Clinical Outcomes in Patients With Chronic Renal Insufficiency Presenting With Acute Coronary Syndrome: Data From a Registry of 8176 Patients." Mayo Clinic Proceedings, vol. 85, no. 4, 2010, pp. 332-40.
El-Menyar A, Zubaid M, Sulaiman K, et al. In-hospital major clinical outcomes in patients with chronic renal insufficiency presenting with acute coronary syndrome: data from a Registry of 8176 patients. Mayo Clin Proc. 2010;85(4):332-40.
El-Menyar, A., Zubaid, M., Sulaiman, K., Singh, R., Al Thani, H., Akbar, M., Bulbanat, B., Al-Hamdan, R., Almahmmed, W., & Al Suwaidi, J. (2010). In-hospital major clinical outcomes in patients with chronic renal insufficiency presenting with acute coronary syndrome: data from a Registry of 8176 patients. Mayo Clinic Proceedings, 85(4), 332-40. https://doi.org/10.4065/mcp.2009.0513
El-Menyar A, et al. In-hospital Major Clinical Outcomes in Patients With Chronic Renal Insufficiency Presenting With Acute Coronary Syndrome: Data From a Registry of 8176 Patients. Mayo Clin Proc. 2010;85(4):332-40. PubMed PMID: 20360292.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - In-hospital major clinical outcomes in patients with chronic renal insufficiency presenting with acute coronary syndrome: data from a Registry of 8176 patients. AU - El-Menyar,Ayman, AU - Zubaid,Mohammad, AU - Sulaiman,Kadhim, AU - Singh,R, AU - Al Thani,Hassan, AU - Akbar,Mousa, AU - Bulbanat,Bassam, AU - Al-Hamdan,Rashed, AU - Almahmmed,Wael, AU - Al Suwaidi,Jassim, PY - 2010/4/3/entrez PY - 2010/4/3/pubmed PY - 2010/4/20/medline SP - 332 EP - 40 JF - Mayo Clinic proceedings JO - Mayo Clin. Proc. VL - 85 IS - 4 N2 - OBJECTIVE: To assess the impact of chronic renal insufficiency (CRI) on in-hospital major adverse cardiac events across the acute coronary syndrome (ACS) spectrum. PATIENTS AND METHODS: From January 29, 2007, through July 29, 2007, 6 adjacent Middle Eastern countries participated in the Gulf Registry of Acute Coronary Events, a prospective, observational registry of 8176 patients. Patients were categorized according to estimated glomerular filtration rate into 4 groups: normal (>or=90 mL/min), mild (60-89 mL/min), moderate (30-59 mL/min), and severe CRI (<30 mL/min). Patients' characteristics and in-hospital major adverse cardiac events in the 4 groups were analyzed. RESULTS: Of 6518 consecutive patients with ACS, 2828 (43%) had mild CRI, 1304 (20%) had moderate CRI, and 345 (5%) had severe CRI. In CRI groups, patients were older and had a higher prevalence of hypertension, diabetes mellitus, and dyslipidemia. On admission, these patients had a higher resting heart rate and frequently had atypical and delayed presentations. Compared with the normal estimated glomerular filtration group, CRI groups were less likely to receive antiplatelet drugs, beta-blockers, angiotensin-converting enzyme inhibitors, and statins and were less likely to undergo coronary angiography. In-hospital heart failure, cardiogenic shock, and major bleeding episodes were significantly higher in all CRI groups. In multivariate analysis, mild, moderate, and severe CRI were associated with a higher adjusted odds ratio (OR) of death (mild: OR, 2.1; 95% confidence interval [CI], 1.2-3.7; moderate: OR, 6.7; 95% CI, 3.9-11.5; and severe: OR, 12.0; 95% CI, 6.6-21.7). CONCLUSION: Across the ACS spectrum, patients with CRI had a worse risk profile, had more atypical and delayed presentations, and were less likely to receive evidence-based therapy. Chronic renal insufficiency of varying stages is an independent predictor of in-hospital morbidity and mortality. SN - 1942-5546 UR - https://www.unboundmedicine.com/medline/citation/20360292/In_hospital_major_clinical_outcomes_in_patients_with_chronic_renal_insufficiency_presenting_with_acute_coronary_syndrome:_data_from_a_Registry_of_8176_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0025-6196(11)60425-4 DB - PRIME DP - Unbound Medicine ER -