In-Hospital Prognostic Value of Glomerular Filtration Rate in Patients With Acute Coronary Syndrome and a Normal Creatinine Level

Kidney failure is more prevalent in patients with ischemic heart disease than in the general population. A high serum creatinine level is known to be a predictor of an adverse outcome in acute coronary syndrome. The aim of this study was to investigate the clinical significance of the glomerular filtration rate in patients with acute coronary syndrome and a normal baseline creatinine level. The study included 583 consecutive patients admitted to a coronary care unit with acute coronary syndrome (with or without ST-segment elevation) whose baseline serum creatinine level was less than 1.3 mg/dL. The creatinine clearance rate at admission was calculated using the Cockcroft-Gault equation, and the presence of cardiovascular risk factors, coronary anatomy (from angiography), type of revascularization, maximum cardiac enzyme levels, left ventricular ejection fraction and, ultimately, in-hospital mortality were recorded. Around 50.8% of patients presented with ST-segment elevation acute coronary syndrome. The median serum creatinine level on admission was 0.98 mg/dL (0.9-1.1 mg/dL) and the median creatinine clearance rate was 81.29 mL/min (61.2-98.4 mL/min). The in-hospital mortality rate was 2.7%. Glomerular filtration rate, previous coronary disease, Killip class on admission, and the need for intraaortic balloon counterpulsation were found to be independent predictors of mortality. In patients with acute coronary syndrome and a normal creatinine level on admission, estimation of the glomerular filtration rate provided important information on short-term prognosis. This parameter should be included in the risk assessment of patients with normal serum creatinine levels. La insuficiencia renal es más prevalente en los pacientes con cardiopatía isquémica que en la población general. La presencia de creatinina sérica elevada es un conocido factor de mal pronóstico en el síndrome coronario agudo. En este estudio se evalúa la relevancia clínica del filtrado glomerular renal en los pacientes con síndrome coronario agudo y un valor de creatinina basal normal. Se incluyó a 583 pacientes consecutivos que ingresaron en la unidad coronaria con síndrome coronario agudo (con y sin elevación del segmento ST) y creatinina basal < 1,3 mg/dl. Se estimó el filtrado glomerular renal en el momento del ingreso mediante la fórmula de Cockcroft-Gault y se revisó la presencia de factores de riesgo cardiovascular, la anatomía coronaria (coronariografía), el tipo de revascularización, l