Abstract 3478: Does The Way Renal Function is Estimated in Acute Coronary Syndrome Patients Affect The Ability to Predict Outcomes?
Background: Renal failure (RF) is now recognized as an important predictor of adverse outcomes in ACS patients (pts). The Cockcroft-Gault (C-G) equation has been most commonly used to estimate creatinine clearance (CrCl). However, the National Kidney Foundation recommends using the Modification of Diet in Renal Disease (MDRD) equation (which is not dependent on weight and takes into account race), as it may better estimate true GFR. The ability to compare these two equations in prior ACS studies is limited by the inclusion of small numbers of African-Americans (AA) and frequent exclusion of pts with renal failure.
Methods: Consecutive pts without ST elevation on the initial ECG admitted for exclusion of ACS underwent serial assessment of CK, CK-MB and TnI. Admission creatinine was used to estimate renal function. MI was defined based on having TnI elevations using ACC/ESC criteria. One year mortality was compared in pts based on race and TnI status.
Results: Over a 4 year period, 4,343 pts (49% F, 64% AA) were admitted, of whom 16% had TnI elevations. Overall one year mortality was 10.4%. Concordance between the two equations for the 3 CrCl and GFR groups was 90%. The relationship between one year mortality and renal function, based on C-G versus MDRD equations is shown in the Table⇓. There were no significant differences based on race or TnI status.
Conclusions: Mortality increases with worsening renal function. Both the C-G and MDRD equations equally predict 1 year mortality in ACS pts.