Chronic kidney disease in acute coronary syndromes

Table 1 Most important studies on the in-hospital and long-term prognostic relevance of chronic kidney disease in acute coronary syndromes

Source	Year	Kind of ACS	No. of patients	Evaluated mortality	CKD definition and severity	Mortality rate in CKD patients (%)	Mortality rate in no-CKD patients (%)	Comment
Herzog et al[3]	1998	STEMI	34 189	In-hospital	Patients in dialysis	26	-	Included pts with a first STEMI after dialysis initiation
				1-yr		59
				2-yr		73
				3-yr		81
				5-yr		90
				10-yr		97
Chertow et al[4]	2000	STEMI	640	30-d (1-yr)	Patients in dialysis	20 (53)	-	Only 7% of pts were treated with PCI and 5% with CABG
McCullough et al[20]	2000	STEMI/NSTEMI	9544	Mean follow-up: 27.1 mo	CrCl > 81.5 mL/min	30.5	14.6	-
					81.5-63.1 mL/min	54.5	22.7
					63.1-46.2 mL/min	65
					< 46.2 mL/min
					Dialysis
Beattie et al[5]	2001	STEMI	1724	In-hospital	CrCl > 81 mL/min	OR 3.88	OR 1	Age- and sex-adjusted risks for in-hospital death
					80-63 mL/min	OR 8.76	OR 2.45
					62-46 mL/min	OR 5.43
					< 46 mL/min
					HD
Wright et al[6]	2002	STEMI	3106	In-hospital	ClCl > 75 mL/min	6	2	-
					75-51 mL/min	14
					50-35 mL/min	21
					< 35 mL/min	30
					HD
Shlipak et al[7]	2002	STEMI	130 099	1-yr	sCr < 1.5 mg/dL	46	24	Included pts with > 65 yr
					1.5-2.4 mg/dL	66
					2.5-3.9 mg/dL
Sorensen et al[22]	2002	STEMI	6252	6-yr	CrCl > 85 mL/min	62	22.5	-
					85-71 mL/min	83	32
					70-56 mL/min		46
					55-41 mL/min
					< 40 mL/min
Santopinto et al[8]	2003	STEMI	4716	In-hospital	CrCl > 60 mL/min	8.1	2.1	-
					30-60 mL/min	18.1
					< 30 mL/min
Santopinto et al[8]	2003	NSTEMI/UA	7058	In-hospital	CrCl > 60 mL/min	3.8	0.9
					30-60 mL/min	8.5
					< 30 mL/min
Sadeghi et al[34]	2003	STEMI	2082	30-d (1 yr)	CrCl < 60 mL/min	7.5 (12.7)	0.8 (7.5)	Primary PCI Excluded pts with sCr > 2 mg/dL or CS
Hobbach et al[38]	2003	STEMI	352	30-d (6-mo)	sCr > 1.2-2.8 mg/dL	16 (19.5)	3.4 (4.5)	Included pts treated with systemic thrombolysis
Berger et al[43]	2003	STEMI	146 765	30-d	Dialysis vs no dialysis patients	29	18.3 (no dialysis)	Included pts with > 65 yr
Freeman et al[61]	2003	STEMI/NSTEMI	889	In-hospital	sCr > 1.5 mg/dL	8.1	2.6	-
Anavekar et al[23]	2004	STEMI	14 527	3-yr	eGFR > 75 mL/min per 1.73 m2	28.9	14.1	Included pts with HF and/or LV systolic dysfunction
					74.9-60 mL/min per 1.73 m2	45.5	20.5
					59.9-45 mL/min per 1.73 m2
					< 45 mL/min per 1.73 m2
Gibson et al[11]	2004	NSTEMI/UA	13 307	30-d (6-mo)	eGFR > 90 mL/min per 1.73 m2	2.1 (3.8)	1.3 (2.5)	-
					89-60 mL/min per 1.73 m2	5 (9.5)
					< 60 mL/min per 1.73 m2
Masoudi et al[12]	2004	STEMI/NSTEMI/UA	2706	7-mo	eGFR > 90 mL/min per 1.73 m2	15	3	-
					89-60 mL/min per 1.73 m2	39	6
					59-30 mL/min per 1.73 m2
					< 30 mL/min per 1.73 m2
Mueller et al[29]	2004	NSTEMI/UA	1400	In-hospital (3-yr)	eGFR > 130 mL/min per 1.73 m2	5.1 (23.2)	0 (7.4)	Included pts with PCI performed within 24 h
					129-90 mL/min per 1.73 m2		0.4 (4.5)
					89-60 mL/min per 1.73 m2		2.6 (8.1)
					< 60 mL/min per 1.73 m2
Dumaine et al[66]	2004	ACS	496	In-hospital	CrCl < 60 mL/min	4.8	0.9	-
Goldberg et al[73]	2005	STEMI	1038	In-hospital (1-yr)	eGFR > 90 mL/min per 1.73 m2	19.9 (29.9)	4.7 (6.7)	-
					89-60 mL/min per 1.73 m2		6.3 (10)
					< 60 mL/min per 1.73 m2
Han et al[74]	2006	NSTEMI/ UA	45 343	In-hospital	sCr > 2.0 mg/dL or dialysis	9	3.6	-
Marenzi et al[40]	2007	STEMI	467	In-hospital	CrCl < 60 mL/min	8.9	3.7	Primary PCI
Fox et al[57]	2007	STEMI	20 479	30-d	CrCl > 90 mL/min	15.30	2.6	Thrombolysis Excluded pts with sCr > 2.5 (men) and > 2.0 (women)
					90-61 mL/min	31.10	7.1
					60-30 mL/min
					< 30 mL/min
Pitsavos et al[75]	2007	STEMI/NSTEMI	2172	In-hospital	CrCl > 60 mL/min	7	2	-
					60-30 mL/min	16
					< 30 mL/min
Inrig et al[76]	2008	ACS	9190	1-yr	eGFR > 90 mL/min per 1.73 m2	6	1.7	-
					90-75 mL/min per 1.73 m2	5.7	2
					75-60 mL/min per 1.73 m2		3.3
					60-45 mL/min per 1.73 m2
					< 45 mL/min per 1.73 m2
Szummer et al[30]	2009	NSTEMI	23 262	1-yr	eGFR > 90 mL/min per 1.73 m2	16.7	5	-
					89-60 mL/min per 1.73 m2	38.2	5.8
					59-30 mL/min per 1.73 m2	51.2
					29-15 mL/min per 1.73 m2
					< 15 mL/min per 1.73 m2/HD
Mehran et al[65]	2009	NSTEMI/UA	12 939	30-d (1-yr)	CrCl < 60 mL/min	3 (7.9)	1.1 (2.8)	Excluded pts with CrCl < 30 mL/min
James et al[50]	2010	STEMI/NSTEMI	15 202	1-yr	CrCl < 60 mL/min	12.1	3.3	Included pts admitted < 24 h from symptoms onset
Fox et al[15]	2010	STEMI	19 089	In-hospital	Stage 3a	8.8	2.3	-
					Stage 3b	17.9
					Stage 4	27.3
					Stage 5	31.8
Fox et al[15]	2010	NSTEMI	30 462	In-hospital	Stage 3a	4.8	1.8	-
					Stage 3b	8.6
					Stage 4	13.4
					Stage 5	12.4
Hachinohe et al[42]	2011	NSTEMI	3615	1-yr	eGFR > 90 mL/min per 1.73 m2	9.4	4	Excluded pts with CS
					89-60 mL/min per 1.73 m2	30	3
					59-30 mL/min per 1.73 m2
					< 30 mL/min per 1.73 m2
Hanna et al[77]	2011	NSTEMI	40 074	In-hospital	eGFR > 60 mL/min per 1.73 m2	2.8	0.6	All pts were treated with PCI
					59-30 mL/min per 1.73 m2	6.1
					29-15 mL/min per 1.73 m2	3.9
					< 15 mL/min per 1.73 m2

ACS: Acute coronary syndromes; CABG: Coronary artery bypass graft; CKD: Chronic kidney disease; CrCl: Creatinine clearance; CS: Cardiogenic shock; eGFR: Estimated glomerular filtration rate; HD: Hemodialysis; HF: Heart failure; LV: Left ventricular; NSTEMI: Non-ST elevation myocardial infarction; OR: Odds ratio; PCI: Percutaneous coronary intervention; sCr: Serum creatinine concentration; STEMI: ST-elevation myocardial infarction; UA: Unstable angina.