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Relationship between renal dysfunction and outcomes in emergency department patients with potential acute coronary
Anna Marie Chang1, Meredith Edwards, Asako C Matsuura
1Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA. changam@uphs.upenn.edu
Insights
Elevated creatinine in emergency department patients with potential acute coronary syndrome (ACS) indicates a higher risk of 30-day cardiovascular (CV) events. However, renal dysfunction is a marker of other CV risks, not an independent predictor.
Area of Science:
- Cardiology
- Nephrology
- Emergency Medicine
Background:
- Acute coronary syndrome (ACS) is a critical condition requiring prompt diagnosis and management.
- Elevated serum creatinine can indicate renal dysfunction, a potential comorbidity affecting cardiovascular outcomes.
- Patients presenting to the emergency department (ED) with potential ACS often have comorbidities that influence their prognosis.
Purpose of the Study:
- To investigate the association between elevated creatinine levels and the risk of acute myocardial infarction (AMI) or 30-day cardiovascular (CV) events in patients with potential ACS.
- To determine if renal dysfunction is an independent predictor of adverse CV outcomes in this patient population.
- To assess the role of elevated creatinine as a marker for other underlying cardiovascular risks.
Main Methods:
- A secondary analysis was conducted on a cohort of patients presenting to the ED with potential ACS.
- Serum creatinine measurements were analyzed, with a cut-off of 132.6 mmol/l used to define abnormal levels.
- Multivariable models, controlling for age, gender, race, cardiac risk factors, and ECG findings, were used to assess the association between abnormal creatinine and outcomes.
Main Results:
- The study included 3451 patients; 10.5% had abnormal creatinine levels.
- Patients with abnormal creatinine had an adjusted odds ratio (OR) of 1.57 (95% CI, 1.10 to 2.25) for 30-day CV events.
- Older age, male sex, white race, hyperlipidemia, hypertension, history of coronary artery disease (CAD), and abnormal ECG were associated with increased odds of 30-day CV events.
Conclusions:
- Renal dysfunction in patients with potential ACS in the ED is associated with an increased likelihood of 30-day CV events.
- Elevated creatinine was not an independent predictor of CV events after controlling for other risk factors.
- Elevated creatinine appears to serve as a marker for other significant cardiovascular risks in patients presenting with potential ACS.
Objectives:
To determine whether patients with elevated creatinine who present to the emergency department (ED) with potential acute coronary syndrome (ACS) are at an increased risk of acute myocardial infarction (AMI) or 30-day cardiovascular (CV) events.
Methods:
A secondary analysis of a cohort study of patients presenting to the ED with potential ACS with serum creatinine measurements. Research assistants collected demographics, history, symptoms, hospital course and 30-day follow-up. Outcomes measured were in-hospital AMI and 30-day CV events (death, nonfatal AMI, revascularisation). Prespecified multivariable models included age, gender, race and cardiac risk factors and presenting electrocardiogram (ECG). We used a creatinine cut-off point of 132.6 mmol/l. Data are presented as OR and 95% CI.
Results:
3451 patients were enrolled (age, 52.9±13.2; 55% female patients; 64% black patients). There were 120 AMI during initial visit and 232 patients had 30-day CV events (43 deaths, 128 AMI, 120 revascularisations). Creatinine values were normal in 3086 (89.4%) and abnormal in 365 (10.5%) patients. In multivariable models the adjusted OR (95% CI) for the association between abnormal creatinine and AMI was 1.43 (0.88 to 2.30) and 30-day CV events was 1.57 (1.10 to 2.25). The odds of 30-day CV events were increased for patients who were older, male subjects, white, had hyperlipidaemia, hypertension or a history of CAD, or presented with an abnormal ECG.
Conclusion:
In patients with potential ACS in the ED, renal dysfunction predicts a higher likelihood of 30-day CV events, but not an independent predictor after controlling for other risk factors. It appears to be a marker of other CV risks.
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