Renal Dysfunction as An Independent Predictor of Total Mortality after Acute Coronary Syndrome: The Thai ACS Registry†
Khorawit Sooklim MD*, Suphot Srimahachota MD*, Smonporn Boonyaratavej MD* Rungsrit Kanjanavanit MD**, Napa Siriviwattanakul MD***, Chumpol Piamsomboon MD****, Rangson Ratanaprakarn MD*****
Affiliation : † On behalf of the Thai Acute Coronary Syndrome Registry (TACSR) Group * Division of Cardiology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok ** Division of Cardiology, Department of Medicine, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai *** Division of Cardiology, Department of Medicine, Rajavithi Hospital, Bangkok **** Division of Cardiovascular Disease, Department of Medicine, Phramongkutklao Hospital, Bangkok ***** Samitive Heart Institute, Samitivej Hospital, Bangkok
Background : Renal insufficiency in the acute coronary syndrome (ACS) is associated with poor cardiac
outcome. In Asian populations, there are no data available for these associations.
Materials and Methods : Data was from the Thai ACS registry, only a new case of ACS. Clinical characteristics,
treatment strategies, in-hospital mortality and 1-year mortality were compared for patients with normal or
mild renal dysfunction (estimated glomerular filtration rate [eGFR] > 60 ml/minute/1.73 m2, n = 809 [44.5%]),
moderate renal dysfunction (eGFR 30-60 ml/minute/1.73 m2, n = 706 [38.9%]), and severe renal dysfunction
(eGFR < 30 ml/minute/1.73 m2, n = 301 [16.6%]).
Results : Of the 1,816 patients with mean follow-up 10.8 months, the mean age was 65 years, and 59.2 percent
of the groups were male. Patients with severe renal dysfunction were significantly older, less likely to be male
(45.2%, p < 0.001) and had a greater prevalence of diabetes (63.1%, p < 0.001) and hypertension (85.4%,
p < 0.001). In-hospital and 1-year mortality were 13.5% and 22.5% respectively. According to discharge
diagnosis, unadjusted hazard ratios for overall in-hospital mortality was statistically significant only in ST
elevation MI subgroup, hazard ratio was 2.73 (95% CI, 1.72 to 4.34) and 6.27 (95% CI, 3.78 to 10.4) for
moderate and severe renal dysfunction group, respectively. The risk of death for all types of ACS at 1-year
follow up increased when eGFR decreased below 60 ml/minute/1.73 m2, the adjusted hazard ratio was 1.66
(95% CI,1.22 to 2.23) and 1.91 (95% CI,1.34 to 2.72) for moderate and severe renal dysfunction group,
respectively.
Conclusion : From Thai ACS registry, renal dysfunction at presentation is an independent predictor for the
overall 1- year mortality and appeared to associate with an increase in hospital mortality in the subsets with
STEMI.
Keywords : Acute coronary syndrome registry, Renal dysfunction, Mortality
