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Estimating glomerular filtration rate in acute coronary syndromes: Different equations, different mortality risk prediction

dc.contributor.authorAlmeida, I
dc.contributor.authorCaetano, F
dc.contributor.authorBarra, S
dc.contributor.authorMadeira, M
dc.contributor.authorMota, P
dc.contributor.authorLeitão-Marques, A
dc.date.accessioned2016-05-11T16:44:19Z
dc.date.available2016-05-11T16:44:19Z
dc.date.issued2015-03-04
dc.description.abstractAIMS: Renal dysfunction is a powerful predictor of adverse outcomes in patients hospitalized for acute coronary syndrome. Three new glomerular filtration rate (GFR) estimating equations recently emerged, based on serum creatinine (CKD-EPIcreat), serum cystatin C (CKD-EPIcyst) or a combination of both (CKD-EPIcreat/cyst), and they are currently recommended to confirm the presence of renal dysfunction. Our aim was to analyse the predictive value of these new estimated GFR (eGFR) equations regarding mid-term mortality in patients with acute coronary syndrome, and compare them with the traditional Modification of Diet in Renal Disease (MDRD-4) formula. METHODS AND RESULTS: 801 patients admitted for acute coronary syndrome (age 67.3±13.3 years, 68.5% male) and followed for 23.6±9.8 months were included. For each equation, patient risk stratification was performed based on eGFR values: high-risk group (eGFR<60ml/min per 1.73m2) and low-risk group (eGFR⩾60ml/min per 1.73m2). The predictive performances of these equations were compared using area under each receiver operating characteristic curves (AUCs). Overall risk stratification improvement was assessed by the net reclassification improvement index. The incidence of the primary endpoint was 18.1%. The CKD-EPIcyst equation had the highest overall discriminate performance regarding mid-term mortality (AUC 0.782±0.20) and outperformed all other equations (ρ<0.001 in all comparisons). When compared with the MDRD-4 formula, the CKD-EPIcyst equation accurately reclassified a significant percentage of patients into more appropriate risk categories (net reclassification improvement index of 11.9% (p=0.003)). The CKD-EPIcyst equation added prognostic power to the Global Registry of Acute Coronary Events (GRACE) score in the prediction of mid-term mortality. CONCLUSION: The CKD-EPIcyst equation provides a novel and improved method for assessing the mid-term mortality risk in patients admitted for acute coronary syndrome, outperforming the most widely used formula (MDRD-4), and improving the predictive value of the GRACE score. These results reinforce the added value of cystatin C as a risk marker in these patients.pt_PT
dc.identifier.citationEur Heart J Acute Cardiovasc Care. 2015 Mar 4. pii: 2048872615576219. [Epub ahead of print]pt_PT
dc.identifier.doi10.1177/2048872615576219pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.4/1906
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.subjectSíndrome Coronária Agudapt_PT
dc.subjectCistatina Cpt_PT
dc.subjectTaxa de Filtração Glomerularpt_PT
dc.titleEstimating glomerular filtration rate in acute coronary syndromes: Different equations, different mortality risk predictionpt_PT
dc.typejournal article
dspace.entity.typePublication
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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