TY - JOUR
T1 - Chronic kidney disease as a risk factor for acute coronary syndromes in patients presenting to the emergency room with chest pain
AU - Khambatta, Sherezade
AU - Farkouh, Michael E.
AU - Wright, R. Scott
AU - Reeder, Guy S.
AU - McCullough, Peter A.
AU - Smars, Peter A.
AU - Hickson, Latonya J.
AU - Best, Patricia J.M.
N1 - Funding Information:
Supported by the Mayo Clinic and Aetna Foundation and made possible by Grant 1 KL2 RR024151-01 from the National Center for Research Resources (NCRR) , a component of the National Institutes of Health (NIH) , and NIH Roadmap for Medical Research.
PY - 2012/5
Y1 - 2012/5
N2 - We sought to determine whether persons with intermediate risk factors for cardiovascular disease presenting to an emergency department with chest pain and chronic kidney disease (CKD) were triaged effectively by chest pain units (CPUs). CPUs evaluate patients with intermediate risk and acute chest pain effectively. CKD is a risk factor for poor outcomes once cardiovascular disease has developed. However, current algorithms to risk stratify patients with acute chest pain do not include renal function. A total of 408 patients enrolled previously in the CHEER study of intermediate risk patients with chest pain, assigned randomly to hospitalization or observation in a CPU where an estimated glomerular filtration rate (GFR) was available, were included. No difference was found in short-term outcomes of patients including in-hospital death, myocardial infarction, or coronary revascularization based on renal function. For the 205 patients randomized to the CPU, the rate of admission to the hospital was significantly higher in the group with CKD compared with the group with normal renal function (68.2 vs 48.2%, P = 0.007). In a multivariate analysis, decreased renal function was not associated with adverse short-term outcomes. On 5 years follow-up, the overall long-term mortality was significantly higher in the group with CKD (14.1% vs 5.5%, P = 0.003). We concluded that CKD is a strong predictor of hospitalization and overall long-term mortality in patients presenting with chest pain to the emergency department. Current risk factor stratification scoring systems should consider CKD as a predictor of increased risk in patients with chest pain.
AB - We sought to determine whether persons with intermediate risk factors for cardiovascular disease presenting to an emergency department with chest pain and chronic kidney disease (CKD) were triaged effectively by chest pain units (CPUs). CPUs evaluate patients with intermediate risk and acute chest pain effectively. CKD is a risk factor for poor outcomes once cardiovascular disease has developed. However, current algorithms to risk stratify patients with acute chest pain do not include renal function. A total of 408 patients enrolled previously in the CHEER study of intermediate risk patients with chest pain, assigned randomly to hospitalization or observation in a CPU where an estimated glomerular filtration rate (GFR) was available, were included. No difference was found in short-term outcomes of patients including in-hospital death, myocardial infarction, or coronary revascularization based on renal function. For the 205 patients randomized to the CPU, the rate of admission to the hospital was significantly higher in the group with CKD compared with the group with normal renal function (68.2 vs 48.2%, P = 0.007). In a multivariate analysis, decreased renal function was not associated with adverse short-term outcomes. On 5 years follow-up, the overall long-term mortality was significantly higher in the group with CKD (14.1% vs 5.5%, P = 0.003). We concluded that CKD is a strong predictor of hospitalization and overall long-term mortality in patients presenting with chest pain to the emergency department. Current risk factor stratification scoring systems should consider CKD as a predictor of increased risk in patients with chest pain.
UR - http://www.scopus.com/inward/record.url?scp=84859722841&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84859722841&partnerID=8YFLogxK
U2 - 10.1016/j.trsl.2011.12.006
DO - 10.1016/j.trsl.2011.12.006
M3 - Article
C2 - 22500512
AN - SCOPUS:84859722841
SN - 1931-5244
VL - 159
SP - 391
EP - 396
JO - Translational Research
JF - Translational Research
IS - 5
ER -