[Renal failure in patients after acute coronary syndrome--does it change the standards? From theory to practice]

Area of Science:

• Cardiology
• Nephrology
• Public Health

Context:

• European Society of Cardiology guidelines recommend similar secondary prevention for acute coronary syndrome patients, regardless of renal function.
• Patients with renal dysfunction often have comorbidities like diabetes, heart failure, and peripheral vessel disease.
• The STOK registry study analyzed secondary prevention in over 31,000 Polish patients post-acute myocardial infarction or unstable angina.

Purpose:

• To compare secondary prevention strategies in acute coronary syndrome survivors with and without renal dysfunction.
• To identify disparities in the application of evidence-based therapies between these patient groups.
• To assess the adherence to established secondary prevention guidelines in a real-world setting.

Summary:

• Analysis of 2,780 patients with elevated creatinine versus 28,585 with normal renal function revealed significant differences.
• Patients with renal dysfunction were more likely to have diabetes, heart failure, and peripheral vessel disease.
• Paradoxically, patients with renal dysfunction received antiplatelet therapy, statins, beta-blockers, and ACE inhibitors less frequently.

Impact:

• Highlights a critical gap between recommended secondary prevention standards and clinical practice for patients with renal dysfunction.
• Suggests a need for improved implementation of evidence-based therapies in this high-risk patient population.
• Underscores the importance of tailored and potentially more aggressive secondary prevention strategies for patients with compromised renal function.