Relationship between renal dysfunction and outcomes in emergency department patients with potential acute coronary syndromes
- Anna Marie Chang1,
- Meredith Edwards2,
- Asako C Matsuura1,
- Kristy M Walsh1,
- Emily Barrows1,
- Jeffrey Le1,
- Judd E Hollander1
- 1Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- 2Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Correspondence to Dr Anna Marie Chang, Hospital of the University of Pennsylvania, Department of Emergency Medicine, Ground Floor, Ravdin Building, 3400 Spruce St. Philadelphia, PA 19104, USA;
Contributors ME, AMC, JL, EB, KMW and JH, conceived the study and designed the trial. JEH obtained research funding. ME, AMC, ACM, EB, JL and JEH supervised the conduct of the trial and data collection. EB, JL and JEH undertook recruitment of participating centres and patients and managed the data, including quality control. AMC, ACM and JEH provided statistical advice on study design and analysed the data. ME and AMC drafted the manuscript, and all authors contributed substantially to its revision. AMC takes responsibility for the paper as a whole and serves as corresponding author.
- Accepted 30 January 2012
- Published Online First 6 March 2012
Objectives To determine whether patients with elevated creatinine who present to the emergency department (ED) with potential acute coronary syndrome (ACS) are at an increased risk of acute myocardial infarction (AMI) or 30-day cardiovascular (CV) events.
Methods A secondary analysis of a cohort study of patients presenting to the ED with potential ACS with serum creatinine measurements. Research assistants collected demographics, history, symptoms, hospital course and 30-day follow-up. Outcomes measured were in-hospital AMI and 30-day CV events (death, nonfatal AMI, revascularisation). Prespecified multivariable models included age, gender, race and cardiac risk factors and presenting electrocardiogram (ECG). We used a creatinine cut-off point of 132.6 mmol/l. Data are presented as OR and 95% CI.
Results 3451 patients were enrolled (age, 52.9±13.2; 55% female patients; 64% black patients). There were 120 AMI during initial visit and 232 patients had 30-day CV events (43 deaths, 128 AMI, 120 revascularisations). Creatinine values were normal in 3086 (89.4%) and abnormal in 365 (10.5%) patients. In multivariable models the adjusted OR (95% CI) for the association between abnormal creatinine and AMI was 1.43 (0.88 to 2.30) and 30-day CV events was 1.57 (1.10 to 2.25). The odds of 30-day CV events were increased for patients who were older, male subjects, white, had hyperlipidaemia, hypertension or a history of CAD, or presented with an abnormal ECG.
Conclusion In patients with potential ACS in the ED, renal dysfunction predicts a higher likelihood of 30-day CV events, but not an independent predictor after controlling for other risk factors. It appears to be a marker of other CV risks.
- Acute coronary syndrome
- acute myocardial infarction
- risk stratification
- cardiorenal syndrome
- accidental falls
- cardiac care
Competing interests None.
Ethics approval This secondary analysis was approved by the Institutional Review Board at the Hospital of the University of Pennsylvania.
Provenance and peer review Not commissioned; externally peer reviewed.