• NEWS . 11 May 2020
  • Baseline renal dysfunction linked to higher mortality in elderly ACS patients undergoing PCI

  • Chronic kidney disease is prevalent in patients admitted with acute coronary syndrome (ACS), and becomes more common with increasing age. 

    In this study, researchers sought to assess the impact of baseline renal function and acute kidney injury on 1-year outcomes of elderly patients with ACS treated with percutaneous coronary intervention (PCI). 

    A total of 1,904 patients were selected among those enrolled in three Italian multicentre studies. They were aged 75 years and older with ACS undergoing successful PCI, and based on the baseline estimated glomerular filtration rate (eGFR), classified as having none or mild (eGFR ≥60 mL/min/1.73 m2), moderate (eGFR 30–59 mL/min/1.73 m2) or severe (eGFR <30 mL/min/1.73 m2) renal dysfunction. 

    Of these, 57% had moderate and 11% had severe renal dysfunction. Patients with renal dysfunction were found to have higher rates (p<0.001) of all-cause mortality (4.5%, 7.5% and 17.8% in patients with none or mild, moderate, and severe renal dysfunction, respectively) and cardiovascular mortality (2.8%, 5.2% and 10.2%, respectively). Additionally, severe renal dysfunction was associated with a higher risk of all-cause mortality (hazard ratio [HR], 2.86; 95% confidence interval [CI], 1.52–5.37; p=0.001) and cardiovascular mortality (HR, 3.11; 95% CI, 1.41–6.83; p=0.005), whereas non-fatal events were unaffected. Acute kidney injury was more prevalent in patients with ST-elevation myocardial infarction than those with non-ST elevation ACS (11.7% vs 7.8%; p=0.036), as well as those with reduced baseline renal function (p<0.001), and was independently associated with 1-year mortality.

    These findings could be helpful to provide insights for the development of specific treatment strategies and planning of secondary prevention measures in this extremely high-risk population. 

    Reference: 
    De Rosa R, et al. Impact of renal dysfunction and acute kidney injury on outcome in elderly patients with acute coronary syndrome undergoing percutaneous coronary intervention. Eur Heart J Acute Cardiovasc Care 2020. doi: 10.1177/2048872620920475. [Epub ahead of print]