EFFECT OF CHRONIC KIDNEY DISEASE ON PROGNOSIS OF PATIENTS WITH ACUTE CORONARY SYNDROME.

OBJECTIVE: Chronic kidney disease (CKD) is associated with worse prognosis in acute coronary syndromes (ACS).We sought to investigate the prognostic effect of conservative management of ACS in CKD patients in a tertiary University Hospital.

DESIGN AND METHOD: Two hundred and one patients (mean age 66.5 ± 13.6 years, 150 males) admitted to our Hospital with ACS from 2016-2017 were included in the study. CKD was defined by an estimated glomerular filtration rate (eGFR) < 60 ml/min/m2, as assessed by the Modification of Diet in Renal Disease (MDRD) equation. We grouped patients into four groups according to their CKD status and whether they underwent coronary angiography or not. Patients were followed for a median of 2 years post the index event. The primary outcome was all-cause death and secondary outcomes were cardiovascular and non-cardiovascular death.

RESULTS: The majority of patients (n = 120, 60%) presented with non-ST elevation ACS (NSTE-ACS), whereas 81 patients as ST-elevation myocardial infarction (STEMI) (40%). 135 patients (68%) had history of hypertension. Fifty-four patients (27%) were identified as CKD patients. Overall, 29 patients (14.4%) did not undergo coronary angiography. Patients at a higher age and with CKD were more likely to not undergo angiography. Thirty-seven (18.4%) died during follow-up (25 non-cardiovascular deaths and 12 cardiovascular deaths). Patients with conservative treatment and CKD had the worse prognosis (Hazard ratio [HR] = 11.00, 95% Confidence intervals [CI] 4.00 to 30.24, p < 0.001) followed by non-CKD patients with conservative treatment (HR = 4.37, 95% CI 1.20 to 15.90, p = 0.025) compared to non-CKD patients treated invasively (reference group) after adjusting for age, gender, STEMI/NSTE-ACS diagnosis. Results were similar for non-cardiovascular death, whereas regarding cardiovascular death only the group with CKD and conservative treatment had a lower survival compared to the reference group (HR = 26.5, 95% CI 2.9 to 241.7, p = 0.004).

CONCLUSIONS: Patients with ACS and CKD have higher mortality from both cardiovascular and non-cardiovascular causes than patients without CKD. Regardless of CKD status, conservative management of ACS was associated with higher long-term mortality versus invasive management in all patients.