[Renal failure stages as predictors of mortality following acute coronary syndrome].

INTRODUCTION: renal glomerular filtration rate on hospital admission in patients presented with an acute coronary syndrome as a predictor for mortality.

PATIENTS AND METHODS: The study analysed 290 patients admitted on hospital with an acute coronary syndrome during one year (2003). Renal function was estimated using the renal glomerular filtration rate by the MDRD formula. Patients were stratified in three groups: patients with a GFR > or = 60 ml/min/1,73 m2; n = 186, patients with GFR < 60 or > 30; n = 93 and patients with GFR < 30; n = 11.

RESULTS: 66.6% of patients were males and 66.5% were older than 65 years old. 54.5% suffered from hypertension and 39% were diabetics. All patients with GFR < 30 ml/min had an acute coronary syndrome without elevation of ST segment. They were the oldest with a major proportion of previous cardiovascular events as cerebrovascular disease, peripheral vascular disease or myocardial infarction. Diagnostic procedures and treatments were less administered in patients with GFR < 30 ml/min. Although in the univariate analysis demonstrated that hospital mortality was related to GFR < 30 ml/min, sex, ageing, Killip > 1, ventricular function and cTnT elevation, only GFR < 30 ml/min, ageing, heart failure and ventricular dysfunction persisted significant in the multivariate analysis. Hospital mortality was 27.3% in patients with GFR < 30 ml/min, 7.5% in patients with GFR between 30-60 ml/min and 3.8% in patients with a GFR > or = 60 ml/min. Mortality after two years follow up was 27.3% in patients with GFR < 30 ml/min, 20.4% in patients with GFR between 30-60 ml/min and 10.2% in patients with a GFR > or = 60 ml/min. Mortality (hospital mortality and after two years of follow up) was increased in patients with GFR< 30 ml/min, ageing, heart failure and diabetes after adjusted for other prognostic factors.

CONCLUSIONS: A reduced glomerular filtration rate is an independent risk factor for mortality in patients with an acute coronary syndrome. Estimation of the renal glomerular filtration rate might be used as prognostic value in these patients.