Impacto da função renal na mortalidade e incidência de eventos cardiovasculares adversos major em doentes com síndromes coronárias agudas

Detalhes bibliográficos
Autor(a) principal: Lourenço, C
Data de Publicação: 2010
Outros Autores: Teixeira, R, António, N, Monteiro, S, Baptista, R, Jorge, E, Gonçalves, F, Monteiro, P, Gonçalves, L, Freitas, M, Providência, LA
Tipo de documento: Artigo
Idioma: por
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10400.4/1243
Resumo: BACKGROUND: Renal failure patients have a dismal prognosis in the setting of acute coronary syndromes (ACS). Several studies have shown that this population is undertreated, benefiting less frequently from cardiovascular agents and interventions. The aim of our study was to evaluate patients hospitalized for ACS who also presented renal dysfunction, identifying baseline clinical characteristics, treatment options and prognosis. We also assessed whether renal failure was an independent predictor of mortality and cardiovascular events. METHODS: We performed an observational, longitudinal, prospective and continuous study, including 1039 consecutive patients hospitalized in a single center for ACS. Two groups were compared according to estimated glomerular filtration rate (eGFR): eGFR > or = 60 ml/min (group A) and eGFR < 60 ml/min (group B). The mean follow-up was twelve months after discharge. Multivariate analysis was used to identify predictors of mortality and major adverse cardiovascular events (MACE) in this population. RESULTS: Group B patients were older and more frequently female, and presented a higher prevalence of cardiovascular risk factors and previous cardiovascular disease, and more severe coronary artery disease. Group B also had more cases of non-ST-elevation acute myocardial infarction, as well as higher blood glucose, higher heart rate on admission, and lower left ventricular ejection fraction. Patients in group B were less frequently treated with the main cardiovascular drugs or by an invasive strategy; this group also presented higher in-hospital mortality (9.1 vs. 2.5%, p < 0.001). During clinical follow-up, survival and MACE-free rates were significantly lower in group B patients (86.6 vs. 93.6%, p < 0.001, and 76.2 vs. 86.2%, p < 0.001, respectively). Multivariate analysis showed that eGFR of < 30 ml/min was an independent predictor of in-hospital mortality (OR 6.92; C statistic = 0.87) and that eGFR of < 60 ml/min was an independent predictor of MACE during follow-up (OR 2.19; C statistic = 0.71). CONCLUSION: We found that moderate to severe renal dysfunction is common in ACS patients, and this variable was an independent predictor of mortality and MACE. However, we also found that these patients are undertreated, which may contribute to their poor prognosis. Early identification of these high-risk patients is important so that the procedures recommended in the international guidelines can be more consistently implemented.
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spelling Impacto da função renal na mortalidade e incidência de eventos cardiovasculares adversos major em doentes com síndromes coronárias agudasImpact of renal function on mortality and incidence of major adverse cardiovascular events following acute coronary syndromesDoenças CardiovascularesSíndrome Coronária AgudaBACKGROUND: Renal failure patients have a dismal prognosis in the setting of acute coronary syndromes (ACS). Several studies have shown that this population is undertreated, benefiting less frequently from cardiovascular agents and interventions. The aim of our study was to evaluate patients hospitalized for ACS who also presented renal dysfunction, identifying baseline clinical characteristics, treatment options and prognosis. We also assessed whether renal failure was an independent predictor of mortality and cardiovascular events. METHODS: We performed an observational, longitudinal, prospective and continuous study, including 1039 consecutive patients hospitalized in a single center for ACS. Two groups were compared according to estimated glomerular filtration rate (eGFR): eGFR > or = 60 ml/min (group A) and eGFR < 60 ml/min (group B). The mean follow-up was twelve months after discharge. Multivariate analysis was used to identify predictors of mortality and major adverse cardiovascular events (MACE) in this population. RESULTS: Group B patients were older and more frequently female, and presented a higher prevalence of cardiovascular risk factors and previous cardiovascular disease, and more severe coronary artery disease. Group B also had more cases of non-ST-elevation acute myocardial infarction, as well as higher blood glucose, higher heart rate on admission, and lower left ventricular ejection fraction. Patients in group B were less frequently treated with the main cardiovascular drugs or by an invasive strategy; this group also presented higher in-hospital mortality (9.1 vs. 2.5%, p < 0.001). During clinical follow-up, survival and MACE-free rates were significantly lower in group B patients (86.6 vs. 93.6%, p < 0.001, and 76.2 vs. 86.2%, p < 0.001, respectively). Multivariate analysis showed that eGFR of < 30 ml/min was an independent predictor of in-hospital mortality (OR 6.92; C statistic = 0.87) and that eGFR of < 60 ml/min was an independent predictor of MACE during follow-up (OR 2.19; C statistic = 0.71). CONCLUSION: We found that moderate to severe renal dysfunction is common in ACS patients, and this variable was an independent predictor of mortality and MACE. However, we also found that these patients are undertreated, which may contribute to their poor prognosis. Early identification of these high-risk patients is important so that the procedures recommended in the international guidelines can be more consistently implemented.Sociedade Portuguesa de CardiologiaRIHUCLourenço, CTeixeira, RAntónio, NMonteiro, SBaptista, RJorge, EGonçalves, FMonteiro, PGonçalves, LFreitas, MProvidência, LA2012-01-11T18:17:17Z20102010-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.4/1243porRev Port Cardiol. 2010;29(9):1331-52.info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-07-11T14:22:30Zoai:rihuc.huc.min-saude.pt:10400.4/1243Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T18:03:47.189143Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Impacto da função renal na mortalidade e incidência de eventos cardiovasculares adversos major em doentes com síndromes coronárias agudas
Impact of renal function on mortality and incidence of major adverse cardiovascular events following acute coronary syndromes
title Impacto da função renal na mortalidade e incidência de eventos cardiovasculares adversos major em doentes com síndromes coronárias agudas
spellingShingle Impacto da função renal na mortalidade e incidência de eventos cardiovasculares adversos major em doentes com síndromes coronárias agudas
Lourenço, C
Doenças Cardiovasculares
Síndrome Coronária Aguda
title_short Impacto da função renal na mortalidade e incidência de eventos cardiovasculares adversos major em doentes com síndromes coronárias agudas
title_full Impacto da função renal na mortalidade e incidência de eventos cardiovasculares adversos major em doentes com síndromes coronárias agudas
title_fullStr Impacto da função renal na mortalidade e incidência de eventos cardiovasculares adversos major em doentes com síndromes coronárias agudas
title_full_unstemmed Impacto da função renal na mortalidade e incidência de eventos cardiovasculares adversos major em doentes com síndromes coronárias agudas
title_sort Impacto da função renal na mortalidade e incidência de eventos cardiovasculares adversos major em doentes com síndromes coronárias agudas
author Lourenço, C
author_facet Lourenço, C
Teixeira, R
António, N
Monteiro, S
Baptista, R
Jorge, E
Gonçalves, F
Monteiro, P
Gonçalves, L
Freitas, M
Providência, LA
author_role author
author2 Teixeira, R
António, N
Monteiro, S
Baptista, R
Jorge, E
Gonçalves, F
Monteiro, P
Gonçalves, L
Freitas, M
Providência, LA
author2_role author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv RIHUC
dc.contributor.author.fl_str_mv Lourenço, C
Teixeira, R
António, N
Monteiro, S
Baptista, R
Jorge, E
Gonçalves, F
Monteiro, P
Gonçalves, L
Freitas, M
Providência, LA
dc.subject.por.fl_str_mv Doenças Cardiovasculares
Síndrome Coronária Aguda
topic Doenças Cardiovasculares
Síndrome Coronária Aguda
description BACKGROUND: Renal failure patients have a dismal prognosis in the setting of acute coronary syndromes (ACS). Several studies have shown that this population is undertreated, benefiting less frequently from cardiovascular agents and interventions. The aim of our study was to evaluate patients hospitalized for ACS who also presented renal dysfunction, identifying baseline clinical characteristics, treatment options and prognosis. We also assessed whether renal failure was an independent predictor of mortality and cardiovascular events. METHODS: We performed an observational, longitudinal, prospective and continuous study, including 1039 consecutive patients hospitalized in a single center for ACS. Two groups were compared according to estimated glomerular filtration rate (eGFR): eGFR > or = 60 ml/min (group A) and eGFR < 60 ml/min (group B). The mean follow-up was twelve months after discharge. Multivariate analysis was used to identify predictors of mortality and major adverse cardiovascular events (MACE) in this population. RESULTS: Group B patients were older and more frequently female, and presented a higher prevalence of cardiovascular risk factors and previous cardiovascular disease, and more severe coronary artery disease. Group B also had more cases of non-ST-elevation acute myocardial infarction, as well as higher blood glucose, higher heart rate on admission, and lower left ventricular ejection fraction. Patients in group B were less frequently treated with the main cardiovascular drugs or by an invasive strategy; this group also presented higher in-hospital mortality (9.1 vs. 2.5%, p < 0.001). During clinical follow-up, survival and MACE-free rates were significantly lower in group B patients (86.6 vs. 93.6%, p < 0.001, and 76.2 vs. 86.2%, p < 0.001, respectively). Multivariate analysis showed that eGFR of < 30 ml/min was an independent predictor of in-hospital mortality (OR 6.92; C statistic = 0.87) and that eGFR of < 60 ml/min was an independent predictor of MACE during follow-up (OR 2.19; C statistic = 0.71). CONCLUSION: We found that moderate to severe renal dysfunction is common in ACS patients, and this variable was an independent predictor of mortality and MACE. However, we also found that these patients are undertreated, which may contribute to their poor prognosis. Early identification of these high-risk patients is important so that the procedures recommended in the international guidelines can be more consistently implemented.
publishDate 2010
dc.date.none.fl_str_mv 2010
2010-01-01T00:00:00Z
2012-01-11T18:17:17Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10400.4/1243
url http://hdl.handle.net/10400.4/1243
dc.language.iso.fl_str_mv por
language por
dc.relation.none.fl_str_mv Rev Port Cardiol. 2010;29(9):1331-52.
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eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Sociedade Portuguesa de Cardiologia
publisher.none.fl_str_mv Sociedade Portuguesa de Cardiologia
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