CLINICAL STUDY
Risks associated with renal dysfunction in patients in the coronary care unit
Peter A. McCullough, MD, MPH, FACCa,b,c,d,
Sandeep S. Soman, MDa,b,c,d,
Shalin S. Shah, MDa,b,c,d,
Stephen T. Smith, MD, FACCa,b,c,d,
Keisha R. Marks, BSa,b,c,d,
Jerry Yee, MDa,b,c,d and
Steven Borzak, MD, FACCa,b,c,d
a Henry Ford Health System, Department of Internal Medicine,, Detroit, Michigan, USA
b Division of Cardiovascular Disease, Detroit, Michigan, USA
c Division of Hypertension and Nephrology,, Detroit, Michigan, USA
d Henry Ford Heart and Vascular Institute, Detroit, Michigan., USA
Manuscript received August 10, 1999;
revised manuscript received March 1, 2000,
accepted April 13, 2000.
Reprint requests and correspondence: Dr. Peter A. McCullough, Cardiovascular Division, Henry Ford Hospital, Henry Ford Heart and Vascular Institute, William Clay Ford Center for Athletic Medicine, 6525 Second Avenue, Detroit, Michigan 48202
pmc975{at}yahoo.com
OBJECTIVES
The purpose of this study was to quantify the impact of baseline renal dysfunction on morbidity and mortality in patients in the coronary care unit (CCU).
BACKGROUND
The presence of renal dysfunction is an established independent predictor of survival after acute myocardial infarction and revascularization procedures.
METHODS
We analyzed a prospective CCU registry of 12,648 admissions by 9,557 patients over eight years at a single, tertiary center. Admission serum creatinine was available in 9,544 patients. Those not on long-term dialysis were classified into quartiles of corrected creatinine clearance, with cut-points of 46.2, 63.1 and 81.5 ml/min per 72 kg. Dialysis patients (n = 527) were considered as a fifth comparison group.
RESULTS
Baseline characteristics, including older age, African-American race, diabetes, hypertension, previous coronary disease and heart failure, were incrementally more common across increasing renal dysfunction strata. There were graded increases in the relative risk for atrial and ventricular arrhythmias, heart block, asystole, development of pulmonary congestion, acute mitral regurgitation and cardiogenic shock across the risk strata. Survival analysis demonstrated an early mortality hazard for those with renal dysfunction, but not on dialysis, for the first 60 months, followed by graded decrements in survival across increasing renal dysfunction strata.
CONCLUSIONS
Baseline renal function is a powerful predictor of short- and long-term events in the CCU population. There is an early hazard for in-hospital and postdischarge mortality for those with a corrected creatinine clearance <46.2 ml/min per kg, but not on dialysis.
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Abbreviations and Acronyms
| | AMI | = acute myocardial infarction | | BUN | = blood urea nitrogen | | CHF | = congestive heart failure | | cCrCl | = corrected creatinine clearance | | CI | = confidence interval | | CCU | = coronary care unit | | ECG | = electrocardiogram | | LVH | = left ventricular hypertrophy | | RR | = relative risk | | UAP | = unstable angina pectoris |
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