Acute Coronary Syndromes in Chronic Kidney Disease: Clinical and Therapeutic Characteristics

Abstract

Background and Objectives: This study evaluated the clinical characteristics of the acute coronary syndromes (ACS) in chronic kidney disease (CKD) patients and established prognostic values of the biomarkers and echocardiography. Materials and Methods: 273 patients admitted to the cardiology department of the Clinical County Emergency Hospital of Oradea, Romania, with ACS diagnosis were studied. Two study groups were formed according to the presence of CKD (137 patients with ACS + CKD and 136 with ACS without CKD). Kidney Disease: Improving Global Outcomes (KDIGO) threshold was used to assess the stages of CKD. Results: Data regarding the medical history, laboratory findings, biomarkers, echocardiography, and coronary angiography were analysed for both groups. ACS parameters were represented by ST-segment elevation myocardial infarction (STEMI), which revealed a greater incidence in subjects without CKD (43.88%); non-ST-segment elevation myocardial infarction (NSTEMI), characteristic for the CKD group (28.47%, with statistically significance p = 0.04); unstable angina and myocardial infarction with nonobstructive coronary arteries (MINOCA). Diabetes mellitus, chronic heart failure, previous stroke, and chronic coronary syndrome were more prevalent in the ACS + CKD group (56.93%, p < 0.01; 41.61%, p < 0.01; 18.25%, p < 0.01; 45.26%, p < 0.01). N-terminal pro b-type natriuretic peptide (NT-proBNP) was statistically higher (p < 0.01) in patients with CKD; Killip class 3 was evidenced more frequently in the same group (p < 0.01). Single-vessel coronary artery disease (CAD) was statistically more frequent in the ACS without CKD group (29.41%, p < 0.01) and three-vessel CAD or left main coronary artery disease (LMCA) were found more often in the ACS + CKD group (27.01%, 14.6%). Conclusions: Extension of the CAD in CKD subjects revealed an increased prevalence of the proximal CAD, and the involvement of various coronary arteries is characteristic in these patients. Biomarkers and echocardiographic elements can outline the evolution and outcomes of ACS in CKD patients.

Diagnosis and management of pericardial effusion

“…Another review reported that the incidence of tuberculous pericarditis is increasing in Africa, as a result of the HIV epidemic [6]. Pericardial effusion can be secondary to noninfectious diseases, such as autoimmune diseases (systemic lupus erythematosus, rheumatoid arthritis, Sjogren syndrome, sarcoidosis), primary tumors (pericardial mesothelioma) or secondary tumors (most common lung cancer and breast cancer, lymphomas and melanoma), acute myocardial infarction (Dressler syndrome), chronic renal failure [8], hypothyroidism (myxedema), mediastinal radiation, direct injury (penetrating thoracic injury), drugs (especially procainamide, hydralazine), and after an invasive cardiac procedure (post-pericardiotomy syndrome), or it may have hemodynamic causes (heart failure, pulmonary hypertension) [3]. In a study that enrolled 114 patients with neoplasia, pericardial diseases were diagnosed in 18% of cases throughout the monitoring period [9].…”

The infection with new coronavirus SARS-CoV-2

“…According to a report by the Chinese Center for Disease Control and Prevention, there are three degrees of damage induced by infection with SARS-CoV-2, listed in Table 3 [16,27]. In most cases, the damage caused by this infection is not severe and death generally occurs among patients who have significant comorbidities (cardiovascular disease [28,29], diabetes [30,31], chronic respiratory disease, hypertension [32,33], cancer, etc).…”

Extrahepatic blood supply to hepatocellular carcinoma – a pictorial essay

“…Depending on the value of GFR and albuminuria, CKD is divided into five stages. Its importance is given by the fact that all CKD stages are associated with the increase of the risk of cardiovascular morbidity, the decrease of the quality of life and premature deaths, representing the ninth cause of death in the USA 8 . Most often, between CKD and cardiovascular pathology (especially the presence of hypertension) there is a close relationship, so CKD contributes as an accelerator of CVD and the CVD deteriorates faster the GFR, accelerating CKD progression to stage 5, the final stage of CKD.…”

“…Most often, between CKD and cardiovascular pathology (especially the presence of hypertension) there is a close relationship, so CKD contributes as an accelerator of CVD and the CVD deteriorates faster the GFR, accelerating CKD progression to stage 5, the final stage of CKD. The most common causes of CKD remain high blood pressure, diabetes, atherosclerosis and glomerulonephritis 8 . Patients with CKD stage 1-3 are usually asymptomatic, clinical manifestations begin to appear with reduced GFR, especially in stages 4-5, when hydro-electrolytic disorders (most common hyperkalemia), endocrine disorders (including secondary anemia), metabolic acidosis, caloric protein malnutrition occur, all with a negative impact both on the general condition of the patient and the GFR.…”

“…DM is considered nowadays a global health problem, recent data claiming that in 2017 there were over 450 million diabetic patients; also, it is estimated that in the future the incidence of this disease will rapidly increase 10 , due to some relevant factors included in patient's life style: eating habits, level of physical activity, alcohol consumption, tobacco, and/or drugs, etc. The importance of this condition is based on the risk of premature death, representing itself an independent cardiovascular risk factor for CKD and many other complications (micro and macrovascular), that not only strongly influence the quality of life but also the morbidity and mortality (increasing by 2-4 times the cardiovascular mortality) 8,11 .…”