The association between in-hospital new-onset moderate kidney injury and adverse outcomes in patients with acute coronary syndrome: findings from the CCC-ACS project

In acute coronary syndrome (ACS), severe or chronic kidney injury (KI) is well established to link with adverse outcomes and targeted in guidelines. However, new-onset moderate KI is a common but underrecognized condition with unknown prognostic value in ACS. This study assessed the association between new-onset moderate KI and adverse outcomes in this population. Using data from the CCC-ACS, patients with ACS and normal renal function at admission (eGFR > 90 mL/min/1.73 m 2 ) were stratified by in-hospital eGFR. In-hospital outcomes were major bleeds, ischemic events, and mortality. Cox proportional hazards models, inverse probability weighting, and 1:1 propensity score matching were employed to investigate the association between in-hospital treatment and the risk of moderate KI. Of 51,351 evaluable patients, 8131 (15.8%) individuals were found to have developed in-hospital KI. There was a nonlinear association of eGFR with adverse outcomes. Moderate KI (eGFR: 60–75 mL/min/1.73 m 2 ) was significantly associated with increased risk for major bleeds (adjusted odds ratio (aOR):1.70; 95% CI 1.23–2.56; P < 0.01) and ischemic events (aOR:1.93; 95% CI 1.16–3.22; P < 0.01). Male, STEMI, out-of-hospital cardiac arrest, fivefold elevated troponin T and I, heart rate > 100 beats/min, triglycerides > 150 mg/dL, and DBP > 90 mmHg were identified as risks of moderate KI. Clopidogrel (adjusted HR:0.76; 95% CI 0.70–0.81) was linked to a decreased likelihood of moderate KI. In a nationwide ACS registry, new-onset moderate KI accounts for 21.5% of all new-onset KI and is independently associated with higher in-hospital adverse event risk. These hypothesis-generating findings may inform future risk stratification and therapeutic optimization efforts, but require validation in prospective studies (CCC Project-Acute Coronary Syndrome; NCT02306616, November 29, 2014).