The Effect of Renal Function on the Treatment and Outcome of Patients with Acute Coronary Syndrome - The 63rd Annual Conference of the Israel Heart Society in association with the Israel Society of Cardiothoracic Surgery 12-13 April 2016, David Intercontinental Hotel, Tel-Aviv, Israel

Zach Rozenbaum ¹ Sydney Benchetrit ⁵ Mony Shuvy ^2,3 Yoram Neuman ^4,5 Meital Shlezinger ⁶ Ilan Goldenberg ^5,6 Morris Mosseri ^4,5 David Pereg ^4,5

¹Department of Internal Medicine D, Sourasky Medical Center, Tel Aviv
²Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba
³Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem
⁴Department of Cardiology, Meir Medical Center, Kfar Saba
⁵Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv
⁶Department of Cardiology, Sheba Medical Center, Tel hashomer

Introduction: Chronic kidney disease is a frequent comorbidity among patients with acute coronary syndrome (ACS). We aimed to evaluate treatment characteristics in ACS patients according to their renal function and to assess the effect of differences in therapy on clinical outcomes.

Methods: Included were patients with ACS enrolled in the Acute Coronary Syndrome Israeli biennial Surveys (ACSIS) during 2000-2013. Excluded were patients with cardiogenic shock at presentation. The estimated glomerular filtration rate (GFR) was calculated using the simplified Modification of Diet in Renal Disease (MDRD) formula. The distribution of the estimated GFR was divided into 4 categories (below 45, 45-59.9,60-74.9, and above 75 mL/min/1.73m²). The primary endpoint was all-cause mortality at 1 year.

Results: A total of 13,194 patients with ACS were included. Patients with reduced estimated GFR were less likely to be admitted to a coronary care unit and had lower rates of coronary angiograms and subsequent percutaneous coronary interventions (PCI). Furthermore, as the estimated GFR was lower, patients were less frequently treated with aspirin, clopidogrel, beta-blockers and ACE-I/ARBs. We demonstrated an inverse association between renal function and 1-year mortality with the highest mortality rates observed in the group with the lowest estimated GFR (HR=3.8,95%,CI=2.9-4.9,p<0.0001). Mortality differences remained significant following a multivariate analysis for all the baseline characteristics as well as for in-hospital treatment (HR=2.7,95%,CI=1.9-3.7, p<0.0001).

Conclusions: ACS patients with reduced renal function represent a high risk group with increased mortality risk. Despite this high risk, these patients are less frequently being selected for an invasive treatment strategy and are less commonly treated with guideline-based medications. However, these variations in therapy can only partially explain the differences in outcomes.