The Impact Of Mild Renal Abnormalities On Prognosis Of Acute Coronary Syndrome With Percutaneous Coronary Intervention

Background:Different level of Chronic renal abnormalities (CRA) is very common in patients with Acute Coronary Syndrome (ACS) and have an adverse impact to the outcome of these people who have received Percutaneous Coronary Intervention (PCI). Mild chronic renal abnormalities is rather common in patients with ACS but the patient’s self-awareness is low, The domestic ACS-PCI research group have pointed out that mild chronic renal abnormalities (60ml/min/1.73m2<eGFR<89ml/min/1.73m2) in the patients undergoing PCI is49.5%, in the contrast, the self-awareness rate is only2.51%.Chronic Kidney Disease (CKD) especially End Stage Renal Disease (ESRD) increased the prevalence and mortality of ACS patients has been confirmed by a large number of epidemiological studies. But researches specific to the relationship between Mild Chronic renal abnormalities (CRA) and the outcomes for ACS patients are rare. Several foreign studies have found that even the slightest chronic renal abnormalities will also affect the long-term prognosis of ACS patients with PCI. This study is aimed to investigate the association between mild chronic renal abnormalities and the clinical outcomes of ACS patients who received PCI.Objective:The study determined the real renal function status of ACS patients,whose serum creatinine in the normal range, analyzed the predictive value of mild chronic renal abnormalities (eGFR60-89ml/min/1.73m2) to poor prognosis in ACS patients who received PCI,and explore the dependent predictive factor that affecting the progonosis.Methods:To choose the patients in lanzhou military region general hospital during January2011to December2012hospitalized in the department of cardiology, who received interventional therapy successfully and meets the criteria standard with ACS. Inclusion criteria:(1) age>18;(2)Meet the standard definition diagnosed with ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction,(NSTEMI) or unstable angina(UA);(3) coronary angiography showed at least a degree of vascular stenosis greater than50%and successfully received PCI.Exclusion criteria:(1) the serum creatinine>133umol/L;(2) has obvious physical defects that significantly affect serum creatinine level;(3) the condition of the patients with congenital heart disease, valvular heart disease, cardiomyopathy, or other cardiovascular disease (CVD);(4) with malignant tumours, connective tissue disease, chronic inflammation or other researchers think that can limit the life expectancy of severe concurrent disease;(5) any conditions that may significantly limit the completion of follow-up.Methods:Collect the baseline demographic data and clinical data of all the patients, including age, gender, height, weight, serum creatinine, blood uric acid, left ventricular ejection fraction, history of smoking,hypertension, diabetes mellitus and hyperlipidemia etc.Apply the simplified MDRD equation [(Abreviated Modifieation of Dietin takes diseases equation):eGFR (ml/min1.73m2)=186x (Scr) to1.154x (age) to0.203x (0.742women)] estimated glomerular filtration rate. Evaluate the renal function and dvided all the patients into three groups according to the level of eGFR:mild chronic renal abnormalities group (eGFR60-89ml/min/1.73m2), moderate chronic renal abnormalities (CRA) group (eGFR30-59ml/min/1.73m2) and normal renal function group (eGFR>90ml/min/1.73m2). Make follow-up by telephone or outpatient and record occurrence of Major adverse cardiac and cerebrovascular events(MACCE), including all-cause death, nonfatal myocardial infarction, heart failure, stroke,. All-cause death and1year after discharge as the end of follow-up and then make a data summary analysis. Compare the clinical characteristics among mild,moderate chronic renal abnormalities group and normal renal function group; Analysis risk factor related to the MACCE, further apply Logistic regression model to explore the independent predictive factors associated with poor prognosis.Results:(1) The average age was (60.88+11.73) and77.97%of the population is male (138/177),39cases is female (22.03%), The STEMI patients cases is99(55.9%),NSTEMI24cases (13.6%), UA54cases (30.5%).(2) Mild renal abnormalities group,moderate renal abnormalities group and normal renal function group were62.71%,15.25%and22.03%respectively.(3) Compared with normal renal function group,patients in mild-to-moderate renal abnormalities group were older, often had history of smoking and more than2pathological coronary artery(P<0.05).(4) Compared with non MACCE group, MACCE group were older.with low LVEF, the history of smoking, diabetes and hyperlipidemia were more obvious.,their eGFR value is relatively low, had more than3pathological coronary artery (P<0.05).(5)Comparing the incidence of MACCE in different renal function group, all-cause mortality and incidence of MACCE had statistically difference (P<0.05).(6)Logistic regression analysis showed that only Age and low LVEF(<40%) were the independent predictive factors influencing the prognosis of ACS patients with PCI, eGFR did not show obvious correlation.Conclusion:.1. Mild renal abnormalities is common in ACS patients with normal serum creatinine who receivied Percutaneous Coronary Intervention. 2. The all-cause mortality and the total incidence of MACCE in mild-moderate renal abnormalities group are significantly higher than that in normal renal function group.3. Logisitic regression analysis didn’t show significant correlation between mild renal abnormalities and poor prognosis,only age and LVEF are independent predictors that affecting prognosis.