Introduction: Unrecognized renal insufficiency (RI) ,defined as eGFR2 in the presence of normal serum creatinine, is common among patients with acute coronary syndrome (ACS). The aim of our study was to determine the prevalence of unrecognized renal insufficiency in a large unselected/ population of patients with ACS and to assess its clinical significance compared with recognized renal insufficiency and normal renal function.
Methods: The study population consisted of patients with ACS included in the Acute Coronary Syndrome Israeli biennial Surveys (ACSIS) during 2000-2013. Patients who presented with cardiogenic shock were excluded. The eGFR was calculated using the simplified Modification of Diet in Renal Disease (MDRM) formula. Patients were stratified into three groups: (1) normal renal function ( eGFR ≥60 mL/min/1.73m2 with serum creatinine≤1.2 mg/dl), (2) unrecognized RI ( eGFR2 with serum creatinine ≤1.2 mg/dl) and (3) recognized RI ( eGFR2 with serum creatinine ≥1.2 mg/dl). The primary endpoint was all-cause mortality at 1 year.
Results: Included in the study were 12,830 patients with ACS. Unrecognized RI was present in 2,536 (19.8%). Patients with unrecognized RI were older and more frequently females. All -cause mortality rates at 1-year were highest among patients with recognized RI followed by patients with unrecognized RI, with the lowest mortality rates observed in patients with normal renal function (19.4, 9.9, 3.3% respectively, p<0.0001).
Conclusions: ACS patients with unrecognized RI should be considered as high risk population. The question whether this group would benefit from a more aggressive therapeutic approach should still be evaluated.
