In-hospital Major Clinical Outcomes in Patients With Chronic Renal Insufficiency Presenting With Acute Coronary Syndrome: Data From a Registry of 8176 Patients

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 (≥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, β-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.ACS = acute coronary syndrome; CI = confidence interval; CrCl = creatinine clearance; CRI = chronic renal insufficiency; eGFR = estimated glomerular filtration rate; GRACE = Global Registry of Acute Coronary Events; Gulf RACE = Gulf Registry of Acute Coronary Events; MACE = major adverse cardiac event; NSTACS = non–ST-segment elevation ACS; OR = odds ratio; SCr = serum creatinine; STEMI = ST-segment elevation myocardial infarctionChronic renal insufficiency (CRI) is a well-established risk factor and predictor of mortality in patients with coronary artery disease.^1-8 However, the impact of varying stages of CRI in patients with the entire acute coronary syndrome (ACS) spectrum has been less extensively studied. The objective of the current study was to evaluate the prognostic impact of the CRI stages on the in-hospital mortality and major adverse cardiac events (MACEs) across the ACS population, including patients with ST-segment elevation myocardial infarction (STEMI) and non–ST-segment elevation ACS (NSTACS).