Renal Dysfunction As a Predictor of Long-Term Mortality in Middle-Aged Women Following an Acute Coronary Syndrome

Abstract

To evaluate the association between renal dysfunction and long-term prognosis among middle-aged women surviving an acute coronary syndrome (ACS). The Stockholm Female Coronary Risk Study included 291 women <66 years of age, hospitalized for an ACS during the years 1991-1994 in the greater Stockholm area. All patients underwent clinical screening for cardiovascular prognostic factors, including blood samples 3 to 6 months after the event. Creatinine clearance (CCr) was calculated using the Cockcroft-Gaults formula and related to adverse outcome. Hazard ratios (HR) for all-cause and cardiovascular mortality, respectively, in each tertile of CCr, were estimated using Cox proportional hazards regression. There were 40 deaths, including 23 from cardiovascular causes, during a median follow-up of 9 years. The unadjusted HRs for all-cause mortality for the 1st (CCr < 78 mL/min) and 2nd (CCr 78-96 mL/min) tertiles of CCr were 3.17 (95% confidence interval [CI] 1.34-7.45) and 1.76 (95% CI 0.69-4.48), respectively, compared with the 3rd (CCr > 96 mL/min) tertile. The corresponding HRs for cardiovascular mortality were 3.66 (95% CI 1.20-11.1) and 1.28 (95% CI 0.34-4.76). After multivariable adjustment for potential confounders, the association between all-cause mortality and CCr in the 1st compared with the 3rd tertile remained statistically significant (HR 4.37, 95% CI 1.39-13.7). Renal dysfunction is related to long-term mortality in middle-aged women hospitalized for ACS.