Renal dysfunction, coronary revascularization and mortality among elderly patients with non ST elevation acute coronary syndrome

Nuccia Morici, Stefano De Servi, Anna Toso, Ernesto Murena, Federico Piscione, Leonardo Bolognese, Anna S onia Petronio, Roberto Antonicelli, Claudio Cavallini, Fabio Angeli, Stefano Savonitto

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)453-460
Number of pages8
JournalEuropean Heart Journal: Acute Cardiovascular Care
Volume4
Issue number5
DOIs
Publication statusPublished - Oct 1 2015

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Acute Coronary Syndrome
Creatinine
Kidney
Mortality
Prospective Studies
Serum
Population

Keywords

  • acute myocardial infarction
  • chronic
  • percutaneous coronary intervention
  • renal disease

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Renal dysfunction, coronary revascularization and mortality among elderly patients with non ST elevation acute coronary syndrome. / Morici, Nuccia; De Servi, Stefano; Toso, Anna; Murena, Ernesto; Piscione, Federico; Bolognese, Leonardo; Petronio, Anna S onia; Antonicelli, Roberto; Cavallini, Claudio; Angeli, Fabio; Savonitto, Stefano.

In: European Heart Journal: Acute Cardiovascular Care, Vol. 4, No. 5, 01.10.2015, p. 453-460.

Research output: Contribution to journalArticle

Morici, Nuccia ; De Servi, Stefano ; Toso, Anna ; Murena, Ernesto ; Piscione, Federico ; Bolognese, Leonardo ; Petronio, Anna S onia ; Antonicelli, Roberto ; Cavallini, Claudio ; Angeli, Fabio ; Savonitto, Stefano. / Renal dysfunction, coronary revascularization and mortality among elderly patients with non ST elevation acute coronary syndrome. In: European Heart Journal: Acute Cardiovascular Care. 2015 ; Vol. 4, No. 5. pp. 453-460.
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abstract = "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.",
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AU - Toso, Anna

AU - Murena, Ernesto

AU - Piscione, Federico

AU - Bolognese, Leonardo

AU - Petronio, Anna S onia

AU - Antonicelli, Roberto

AU - Cavallini, Claudio

AU - Angeli, Fabio

AU - Savonitto, Stefano

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AB - 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.

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