Disparities in the Estimation of Glomerular Filtration Rate According to Cockcroft‐Gault, Modification of Diet in Renal Disease‐4, and Chronic Kidney Disease Epidemiology Collaboration Equations and Relation With Outcomes in Patients With Acute Coronary Syndrome

Abstract

BackgroundA simple method to assess renal function is the estimated glomerular filtration rate, and it shows prognostic implications. However, it remains unknown which equation should be used in patients with acute coronary syndrome. We compared the ability and correlation of the Cockcroft‐Gault, Modification of Diet in Renal Disease‐4 (MDRD‐4), and Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) equations and their predictive performance for major adverse cardiovascular events, all‐cause mortality, and major bleeding in a cohort of patients with acute coronary syndrome.Methods and ResultsMulticenter prospective registry involving 1699 consecutive patients with acute coronary syndrome from 3 tertiary institutions. At entry, renal function was assessed using the Cockcroft‐Gault, MDRD‐4, and CKD‐EPI‐creatinine equations. During 12 months of follow‐up, we recorded all major adverse cardiovascular events (composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal ischemic stroke), bleeding events (Bleeding Academic Research Consortium classification), and all‐cause mortality. Receiver operating characteristic curve comparisons demonstrated that Cockcroft‐Gault equation had higher predictive ability compared with MDRD‐4 equation for major adverse cardiovascular events (0.651 versus 0.616; P=0.023), major bleeding (0.600 versus 0.551; P=0.005), and all‐cause mortality (0.754 versus 0.717; P=0.033), as well as higher predictive ability compared with CKD‐EPI equation for major bleeding (0.600 versus 0.564; P=0.018). Integrated discrimination improvement and net reclassification improvement analyses showed superior discrimination and reclassification of Cockcroft‐Gault equation. Decision curve analyses graphically demonstrated higher net benefit and clinical usefulness of the Cockcroft‐Gault equation in comparison with MDRD‐4 and CKD‐EPI equations.ConclusionsIn patients with acute coronary syndrome, the Cockcroft‐Gault equation presented superior predictive ability for major adverse cardiovascular events, major bleeding, and all‐cause mortality compared with MDRD‐4 equation, and superior predictive ability for major bleeding compared with CKD‐EPI equation. The Cockcroft‐Gault equation also showed higher net benefit and clinical usefulness.

Shock Index-C: An Updated and Simple Risk-Stratifying Tool in ST-Segment Elevation Myocardial Infarction

“…Cywinski et al showed that estimated renal function was a better prognostic indicator than Scr (30). CCr by Cockcroft-Gault has adequate discriminatory ability, with an AUC > 0.8 for prediction of poor outcomes, which was better than other equations for glomerular filtration rate estimation in patients with acute coronary syndrome (31,32). In addition, renal function is an important element in the GRACE, Mehran, and CRUSADE scales (7,11,12).…”

Thromboembolic and Hemorrhagic Outcomes in the Direct Oral Anticoagulant Trials Across the Spectrum of Kidney Function

“…1,26 Concordant with the literature, the correlation between CrCL (using the Cockcroft and Gault equation), 31 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 32 GFR, and the MDRD GFR 27 ARTICLE correlation coefficients 0.69-0.71 and 0.64-0.66, respectively) than that between the MDRD-GFR and CKD-EPI-GFR (range 0.96-0.98). [33][34][35] Despite exclusion of patients with severe or endstage renal disease (CrCl < 25 mL/min (apixaban) 19 or < 30 mL/ min (dabigatran, rivaroxaban, and edoxaban), we demonstrate that clinical trials afford a unique opportunity to assess efficacy and safety of therapeutic interventions across the kidney function spectrum. A large proportion of trial participants had GFR between 45 and 60 (25-29%) or GFR < 45 (9.5-12.6%), creating robust subgroups for analyses.…”

Bleeding risk factors in patients with acute coronary syndrome: data from observational studies ORACUL II

“…Ранее в Американском регистре больных с ОКС, включающем 1699 больных из 3 центров, сравнили прогностическую значимость скорость клубочковой фильтрации (СКФ), рассчитанной по формулам MDRD и CKD-EPI, и клиренса креатинина, рассчитанного по формуле Кокрофта-Голта по отношению к риску геморрагических и атеротромботических событий. Оказалось, показатель клиренса креатинина имел большую диагностическую ценность при расчете риска коронарных событий и общей смертности по сравнению со СКФ по формуле MDRD и превосходил СКФ по формуле CKD-EPI при оценке риска кровотечений [30]. В шкале PARIS одним из прогностических факторов является прием антикоагулянтов в составе трой-ной АТТ, в нашей шкале риска любой прием антикоагулянтов оказался предиктором высокого риска кровотечений.…”