Abstract
Backgruond: Chronic kidney disease (CKD) is highly prevalent and associated with an increase of risk to major adverse cardiac and events (MACE) in patients with acute coronary syndrome (ACS). However, there is little information available on the prognostic significance of the difference between whether CKD stage 3a (mild to moderate stage; estimated glomerular filtration rate (eGFR): 45-59 ml/min/1.73m 2 ) and CKD stage 3b (moderate stage; eGFR: 30-44 ml/min/1.73m 2 ) in patients with ACS. Therefore, we assessed to whether the CKD stage might affect the prognosis in patients with ACS. Methods and Results: We followed up 209 patients (72.7% men, mean age 70±11 yrs) with ACS. Patients were classified into 4 groups according to eGFR [groupA: CKD stages 1 and 2, eGFR ≧ 60 ml/min/1.73m 2 (n=82); group B: CKD stage 3a (n=53); group C: CKD stage 3b (n=30); group D: CKD stages 4 and 5, eGFR < 30 ml/min/1.73m 2 (n=44)]. There were no significant differences in baseline clinical characteristic among the four groups. During the follow up period (550±359days), MACE including all-cause mortality, myocardial infarction, and target vessel revascularization were compared among each group. Kaplan-Meier analysis revealed that patients in group C had a significantly higher risk of MACE than those in group B (46% vs 21%, p=0.024). Hazard ratio (HR) for MACE was 5.81(95%CI, 2.59 to 13.31) in group D, 3.95(95%CI, 1.57 to 9.71) in group C and 1.22(95%CI, 0.48 to 2.79) in group B, compared to group A. Notably, patients with group C had a significantly higher risk of MACE than those in group B (HR 3.34; 95%CI,1.25 to 8.87). Conclusion: Patients with moderate CKD (stage 3b) had a higher risk of MACE than those with mild to moderate CKD (stage3a). Thus, we should sub-divide CKD stage 3 into early (3a) and late (3b) components at the evaluation of the subsequent risk of MACE in patients with ACS.
Published Version
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