Acute coronary syndrome and renal impairment: a systematic review

Area of Science:

• Cardiology
• Nephrology
• Internal Medicine

Background:

• Coronary artery disease (CAD) and chronic kidney disease (CKD) share a complex bidirectional relationship.
• Patients with co-existing CAD and CKD exhibit elevated risks for both ischemic and hemorrhagic events.
• Understanding this interplay is crucial for managing cardiovascular and renal health.

Approach:

• This review synthesizes current literature on the link between kidney dysfunction and acute coronary syndromes (ACS).
• It examines risk factors, complications, and prognostic implications of this association.
• Evidence-based strategies for preserving renal function in CAD patients are also discussed.

Key Points:

• CKD patients with CAD are undertreated with invasive procedures like revascularization and potent antithrombotic medications.
• Emerging evidence indicates that a carefully selected invasive approach can be beneficial for these patients, particularly during ACS.
• This highlights a potential gap in current treatment paradigms.

Conclusions:

• The co-existence of CKD and CAD presents significant clinical challenges.
• Further high-quality randomized controlled trials and meta-analyses are essential.
• Defining optimal therapeutic strategies for ACS in this population remains a critical unmet need.