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CLEAR FILTERS
Prognostic impact of estimated glomerular filtration rate in patients with acute coronary syndrome – which is the best formula?
Session:
Sessão de Posters 20 - Doença coronária - marcadores de prognóstico
Speaker:
Catarina Ribeiro Carvalho
Congress:
CPC 2024
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Cartazes
FP Number:
---
Authors:
Catarina Ribeiro Carvalho; Marta Catarina Bernardo; Isabel Martins Moreira; Luís Azevedo; Fernando Fonseca Gonçalves; Pedro Mateus; Ana Baptista; Ilídio Moreira; On Behalf of The Portuguese Registry of Acute Coronary Syndromes
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> chronic kidney disease is a known predictor of poor prognosis in patients with acute coronary syndrome (ACS). For that reason, nowadays is recommended the calculation of the estimated glomerular filtration rate (eGFR) on admission, aiming to predict prognosis. However, there is a paucity of studies regarding the most adequate formula. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose:</strong> to assess and compare the prognosis of patients hospitalized with ACS according to the formula used to calculate the admission eGFR.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>this was a national multicentre retrospective study of patients hospitalized for ACS between October 2010 and October 2022. A total of 32944 patients was included. eGFR was evaluated based on the modification of diet in renal disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD EPI) and Cockcroft-Gault (CG) formulas. In-hospital and 1-year mortality rates were compared for the three groups.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>A total of 23198 patients was selected, 73.0% were males with a mean age of 66±13 years. Mean body mass index (BMI) was 27.4±4.4 kg/m<sup>2</sup>, with 30.0% having normal BMI, 45.4% overweight, 23.9% obesity and 0.7% underweight. Serum creatinine on admission was 1.1±1 mg/dL, and 6.9% of the patients had previous history of chronic kidney disease. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Median eGFR was 82.2 ml/min/1.73m<sup>2</sup> (IQR 62.6-102.8) using the MDRD, 86.5 ml/min/1.73m<sup>2</sup> (IQR 63.4-100.2) with the CKD EPI and 80.9 ml/min/1.73m<sup>2</sup> (IQR 55.6-107.4) using the CG formula.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In-hospital mortality rate was 3.1%. Regarding short-term prognosis, both CKD EPI and CG formulas showed similar discriminatory capacity (<em>p</em>=0.18), with sensitivity of 73.3% and 73.4%, and specificity of 72.2% and 73.4%, respectively. MDRD formula revealed the worst discriminatory capacity (<em>p</em><0.001), with sensitivity of 69.8% and specificity of 74.9%.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Mortality rate increased to 6.1% at 1 year follow-up. When considering long term prognosis, CG formula proved to better predict 1 year mortality (<em>p</em><0.001), with sensitivity and specificity of 66.8 and 74.4%, respectively. CG formula showed the best discriminatory capacity, with an area under the curve (AUC) of 0.76 (95% CI 0.75 – 0.78). By the other hand, CKD EPI and MDRD formulas presented significantly lower AUC, of 0.75 and 0.73 (<em>p</em><0.001).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions: </strong>CG revealed to be the best eGFR formula to predict prognosis of SCA patients. </span></span></p>
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