Renal dysfunction, coronary revascularization and mortality among elderly patients with non ST elevation acute
Nuccia Morici1, Stefano De Servi2, Anna Toso3
1Azienda Ospedaliera Ospedale Niguarda Cà Granda, Italy nuccia.morici@ospedaleniguarda.it.
Insights
Coronary revascularization significantly reduces 1-year mortality in elderly patients with acute coronary syndrome (ACS), regardless of baseline kidney function (creatinine clearance). This intervention is a key predictor of survival in this vulnerable population.
Area of Science:
- Cardiology
- Nephrology
- Geriatrics
Background:
- Elderly patients with acute coronary syndrome (ACS) face high mortality risks.
- Baseline kidney function, measured by creatinine clearance (CrCl), is a critical factor influencing outcomes in ACS.
- The interplay between CrCl, revascularization, and mortality in elderly ACS patients requires further elucidation.
Purpose of the Study:
- To investigate the association between baseline creatinine clearance (CrCl), coronary revascularization, and 1-year mortality in elderly patients with ACS.
- To assess the impact of coronary revascularization on mortality across different CrCl strata in this population.
Main Methods:
- A prospective study included 313 patients aged ≥ 75 years with non-ST-elevation ACS (NSTEACS).
- Creatinine clearance (CrCl) was estimated using the Cockcroft-Gault formula.
- Patients were stratified by CrCl (cutoff 45 ml/min) and treatment (revascularization vs. medical management).
Main Results:
- Patients with impaired renal function receiving medical management had higher in-hospital and 1-year mortality.
- Compared to medically treated patients with preserved renal function, those with impaired renal function treated medically had a 1-year mortality of 22.9% versus 4.9%.
- Coronary revascularization was independently associated with a significantly lower risk of 1-year mortality (HR 0.405; p=0.035) across all CrCl categories.
Conclusions:
- Coronary revascularization improves 1-year survival in elderly patients with NSTEACS, irrespective of their baseline creatinine clearance.
- Revascularization emerges as a powerful independent predictor of favorable 1-year outcomes in this patient group.
- These findings support the consideration of revascularization strategies in elderly ACS patients with varying degrees of renal function.
Aims:
To determine the association between baseline creatinine clearance (CrCl), coronary revascularization during index admission, and 1-year mortality in elderly patients with an acute coronary syndrome (ACS).
Methods And Results:
We estimated CrCl using the Cockcroft-Gault (CG) formula in 313 patients aged ≥ 75 years enrolled in a prospective study of treatment strategies in non ST-elevation ACS (NSTEACS). Patients were stratified into four groups according to CrCl on admission (using a cutoff of 45 ml/min) and coronary revascularization versus medical management. The mean age of the study population was 81 years and the median serum creatinine level on admission was 1.0 mg/dl (interquartile range (IQR) 0.8-1.3). Patients with impaired renal function treated medically had higher in-hospital and 1-year mortality, especially if compared with patients with preserved renal function undergoing revascularization (1-year mortality 22.9% versus 4.9%). Across the spectrum of CrCl categories, coronary revascularization was independently associated with a lower risk of mortality (HR 0.405; 95% CI 0.174-0.940; p=0.035).
Conclusions:
In elderly patients with NSTEACS, coronary revascularization decreases the risk of 1-year death across each CrCl category, and is one of the most powerful predictors of 1-year outcome.
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:26Acute Coronary Syndrome V: Nursing Management