Effect of Kidney Disease on Acute Coronary Syndrome

Abstract

Chronic kidney disease (CKD) is highly prevalent worldwide and is associated with an increased risk for adverse outcomes in patients hospitalized with acute coronary syndrome (ACS). In studies including thousands of patients admitted with myocardial infarction, CKD consistently determines a poorer prognosis for ACS patients. In contrast with CKD, information about the effect of acute kidney injury (AKI) on clinical outcomes after ACS is limited. Most data come from retrospective registry databank studies of nonconsecutive patients with a significant number of patients excluded from analyses. There are no prospective studies designed to determine whether AKI strictly diagnosed by the new the Acute Kidney Injury Network (AKIN) or RIFLE (Risk, Injury, Failure, Loss, and End-stage kidney disease) criteria is a risk factor for death after ACS, and there are no data comparing the RIFLE and AKIN criteria for AKI diagnosis after myocardial infarction. This article reviews the most important data on CKD and ACS and the available data on AKI and ACS. The importance of obtaining an early serum creatinine level after admission for ACS and the importance of renal function monitoring during hospitalization are stressed.

Renal Dysfunction on Admission, Worsening Renal Function, and Severity of Acute Kidney Injury Predict 2-Year Mortality in Patients With Acute Myocardial Infarction

“…9- 15 However, few studies have mentioned the role of AKI by RIFLE classification on AMI patients' outcomes. 16, 17 The purpose of this study was to evaluate the role of initial renal dysfunction on admission, WRF, and the RIFLE classification during hospitalization in predicting the long-term outcomes of AMI patients who survive to discharge.…”

Long-term Clinical Outcomes in Acute Myocardial Infarction Patients with Left Ventricular Dysfunction

“…[25][26][27] ESRD and demonstrates an adaptation of the heart to comply with increased burden of pumping. 29,30 Elderly patients with increased LV mass were shown to be related to higher incidence of MI even though some patients were asymptomatic.…”

Rate versus rhythm control and outcomes in patients with atrial fibrillation and chronic kidney disease: Data from the GUSTO-III Trial

“…CKD is both a risk factor for AF [2,16,17] and an independent predictor of adverse outcomes after acute MI [8,[18][19][20]. The risks of antiarrhythmic therapy may be magnifi ed in patients with CKD, owing to the need for renal dose adjustment of certain antiarrhythmic agents [21], as well as to the co-morbidity that often accompanies CKD and that may promote pro-arrhythmia.…”