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CLINICAL STUDY: ACUTE CORONARY SYNDROME

Influence of concurrent renal dysfunction on outcomes of patients with acute coronary syndromes and implications of the use of glycoprotein IIb/IIIa inhibitors

Rosario V. Freeman, MD, MS^*,*, Rajendra H. Mehta, MD, MS, FACC, Wisam Al Badr, MD, Jeanna V. Cooper, MS, Eva Kline-Rogers, RN, MS and Kim A. Eagle, MD, FACC

^* Division of Cardiology, University of Washington, Seattle, Washington, USA
Division of Cardiology, University of Michigan, Ann Arbor, Michigan, USA

Manuscript received March 27, 2002; revised manuscript received August 14, 2002, accepted August 29, 2002.

^* Reprint requests and correspondence: Dr. Rosario V. Freeman, University of Washington, Division of Cardiology, 1959 NE Pacific Street, Box 356422, Seattle, Washington 98195-6171, USA
rosariof{at}u.washington.edu

OBJECTIVES: The purpose of this study was to examine the in-hospital outcome and influence of glycoprotein (GP) IIb/IIIa antagonists on patients with acute coronary syndromes (ACS) across a range of renal function.

BACKGROUND: Recent studies demonstrate increasing cardiovascular risk with progressive renal dysfunction. Previous studies investigating GP IIb/IIIa antagonist use have excluded patients with renal dysfunction.

METHODS: Patients presenting with ACS between January 1999 and May 2000 were identified, and data on demographics, in-hospital management, and clinical events were collected using standardized definitions. Patients were stratified according to renal function assessed by calculated creatinine clearance (CrCl) at presentation. Primary outcome measures included in-hospital mortality and major bleeding events.

RESULTS: Renal insufficiency was present in 312 of 889 patients. There were 40 in-hospital deaths. In non-dialysis-dependent patients, as CrCl worsened, there was a decline in utilization of routine diagnostics and therapeutics, an increase in in-hospital mortality (p = 0.002), and an increase in major bleeding (p = 0.03). Although the use of GP IIb/IIIa antagonists was associated with an increase in major bleeding (p < 0.001), there was a protective effect on in-hospital mortality (p = 0.04) after controlling for CrCl.

CONCLUSIONS: Renal dysfunction is present in a substantial proportion of patients with ACS and is associated with increased in-hospital death. Although GP IIb/IIIa antagonist use in patients with ACS and renal insufficiency resulted in increased bleeding events, its administration was associated with a decreased risk of in-hospital mortality. These preliminary findings need to be confirmed in future randomized clinical trials.

Abbreviations and Acronyms   ACC/AHA   American College of Cardiology/American Heart Association   ACS   acute coronary syndrome   CI   confidence interval   CrCl   creatinine clearance   GP   glycoprotein   MI   myocardial infarction   OR   odds ratio   PCI   percutaneous coronary intervention

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