Open Access Research article

Impact of impaired glomerular filtration rate and revascularization strategy on one-year cardiovascular events in acute coronary syndrome: data from Taiwan acute coronary syndrome full spectrum registry

Tsung-Hsien Lin12, Ho-Tsung Hsin3, Chun-Li Wang45, Wen-Ter Lai12*, Ai-Hsien Li3, Chi-Tai Kuo45, Juey-Jen Hwang6, Fu-Tien Chiang6, Shu-Chen Chang7, Chee-Jen Chang8 and On behalf of Taiwan ACS Full Spectrum Registry Investigators

Author Affiliations

1 Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Road, Kaohsiung 80708, Taiwan

2 Department of Internal Medicine, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

3 Division of Cardiology, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan

4 Chang Gung University College of Medicine, Taoyuan, Taiwan

5 Division of Cardiology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan

6 Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

7 Division of Biostatistics, Institute of Public Health, National Yang-Ming University, Taipei, Taiwan

8 Graduate Institute of Clinical Medicine, Research Center for Clinical Informatics and Medical Statistics, Chang Gung University, Taoyuan, Taiwan

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BMC Nephrology 2014, 15:66  doi:10.1186/1471-2369-15-66

Published: 23 April 2014

Abstract

Background

The optimal revascularization strategy for patients with impaired glomerular filtration rate (IGFR) has not been established in acute coronary syndrome (ACS). We investigated the prognosis and impact of IGFR and invasive strategy on the cardiovascular outcomes in the ACS population.

Methods

In a Taiwan national-wide registry, 3093 ACS patients were enrolled. The invasive strategy was defined as patients with ST-elevation ACS (STE-ACS) undergoing primary angioplasty or fibrinolysis or coronary angiography with intent to revascularization performed within 72 hours of symptom onset in non-ST-elevation ACS (NSTE-ACS). IGFR was defined as an estimated GFR of less than 60 ml/min per 1.73 m2. Primary endpoint was a composite of death, non-fatal myocardial infarction or stroke at one year.

Results

Patients with IGFR (n = 1226) had more comorbidities but received less evidence-based medications during admission than those without IGFR (n = 1867). The primary endpoint-free survival rate is lower in the IGFR patients, in the whole, STE-ACS and NSTE-ACS population (all log-rank tests p < 0.01). Cox regression analysis revealed IGFR subjects had higher primary endpoint after adjusting by age, sex, medication at discharge and traditional risk factors (all p < 0.01). Kaplan–Meier curves showed IGFR patients without invasive strategy had the worst outcome in the STE-ACS and NSTE-ACS population (both p < 0.01). The invasive strategies, either with early angiography only or angioplasty, were associated with reduced primary endpoints among IGFR patients in the NSTE-ACS population (both p ≦ 0.024).

Conclusions

IGFR patients suffering from ACS had poor prognosis and an invasive strategy could improve cardiovascular outcome in the NSTE-ACS population.

Keywords:
Acute coronary syndrome; Chronic kidney disease; Invasive; Revascularization; Angiography