A STUDY OF PREVALENCE OF CHRONIC KIDNEY DISEASE IN ACUTE CORONARY SYNDROME AND ITS IMPACT ON THE MANAGEMENT AND OUTCOME IN ACUTE CORONARY SYNDROME PATIENTS

Abstract

Background and Objectives: Acute coronary syndromes (ACS) are common in Chronic Kidney Disease and are major source of short term and long term morbidity and mortality in this population. CKD represents a potent and independent risk factor for adverse outcome in ACS patients. Management of patients with CKD presenting with ACS is more complex than in thegeneral population because of the lack of well-designed Randomized trials assessing the rapeutic strategies in such patients. Among ACS patients, Chronic Kidney Disease doubles the death rates and is third only to Cardiogenic Shock and Congestive Heart Failure as apredict or of Mortality. As there is need for improved representation of patients with CKD in Randomized clinical trialsto characterise risks and benefits of medical therapies in ACS patients so as to increase Evidencebased decisions. There are limited data on the prevalence of CKD in Acute Coronary Syndromepatients in Indian population. Hence, this Study was done to determine the prevalence of CKD in ACS patients and find the Management difference in Acute Coronary Syndrome patients with CKD and without CKD and todeterminethe outcome of patientswith CKD. Methods: 150 cases of ACS admitted at a Tertiary Care Hospital meeting the inclusion criteria wereconsidered in 1 year time period. Its a single centred, time bound and prospective study. Patients with Acute Coronary Syndrom eare selected randomly from Cardiology IPD sections and screened. For Serum Creatinine&Urine foralbumin and other relevantinvestigations. Thefollowing investigations were done/Data was collected in the selected patients by using prestructured questionnaire. Data was entered into Microsoft excel data sheet and was analyzedusing SPSS 22version software. Categorical datawas represented in the form of Frequencie sand proportions.Chi-square test was use dastest of significance for qualitative data Continuous data was represented as mean and standard deviation. Independent t test was use dastest of significance to identify the mean difference between two quantitative variables. Results: Inthestudy prevalence of CKD among ACS subjects was 35.3%.FemaleACSsubjects had highest incidence of CKD compared to Males. Among subjects with NSTE-ACS,44.2% had CKD and among Subjects with STEMI, 26% had CKD. Mean EF among CKD subjects was 41.40 ± 7.11% and among those without CKD was 46.06 ± 8.40%. Among CKD subjects17%had mortality and among non CKD subjects 2.1%had mortality. The rewash significant association between mortality and CKD. Interpretation and Conclusion: From the study it was concluded that Prevalence of CKD among ACS subjects was high. With advancemen to fage there was increase inincidence of CKD and female predominance was observed. Co-morbidities such as DM and HTN increases the prevalence of CKD in ACS subjects. NSTEMI had higher incidence of CKD compared toSTEMI. Adequate Medical management and PTCA + Stent improved the outcome among ACS subjects.Mortalitywashigher amongCKDsubjectscompared toNon CKDsubjects.