Key result
Decreased admission creatinine clearance rate (<30 ml/min) in patients with acute coronary syndrome was significantly associated with higher in-hospital mortality (8.8% vs 0%, p=0.001) compared to normal clearance.
Why the study?
Does on-admission creatinine clearance rate predict in-hospital outcomes in patients with acute coronary syndrome?
Observational (n=100)
No
Does on-admission creatinine clearance rate predict in-hospital outcomes in patients with acute coronary syndrome?
Absolute Event Rate: 8.8% vs 0%
p-value: p=0.001
Decreased on-admission creatinine clearance rate is a significant independent predictor of adverse in-hospital outcomes, including mortality and heart failure, in patients with acute coronary syndrome.
Reduced CCR was associated with worse in-hospital ACS outcomes; leaves open whether CCR-guided interventions improve prognosis.
Objective: To find out association between creatinine clearance rate (CCR) and in-hospital outcome of acute coronary syndrome (ACS).Methodology: This prospective observational study was carried on 100 patients with acute coronary syndrome, in Coronary Care Unit (CCU) of BIRDEM General Hospital, Shahbag, Dhaka, over a period of six months from July 1, 2012 to December 31, 2012.Results: Subjects were divided into three groups (A:CCR>60,B :CCR-30-60and C:CCR<30) depending on their CCR (ml/min). Mean creatinine clearance rate was 56.15 (±29.57) ml/min and mean serum creatinine level was 3.68 (±2.59) mg/dl. Among 20 patients of Group A subjects 15(75%) were discharged in a stable condition. 2(10%) and 3(15%) patients developed isolated left ventricular failure (LVF) and isolated hypotension respectively. No patient died in this group and none of them developed any bleeding episode (epistaxis,melaena,haematemesis, haematochezia or per vaginal bleeding etc), sepsis or multi-organ dysfunction syndrome (MODS). Among 35 patients of Group B subjects 8(22.8%) were discharged in a stable condition. 9(25.7%) and 6(17.1%) patients developed isolated LVF and isolated hypotension respectively. 2(5.7%) patients died in this group and 7(20%), 2(5.7%),1(2.8%) patients developed bleeding episode, sepsis and MODS respectively. Among 45 patients of Group C subjects 3(6.6%) were discharged in a stable condition. 12(26.7%) and 8(17.7%) patients developed only LVF and only hypotension respectively . 4(8.8%) patients died in this group during their hospital stay and 11(24.4%), 3(6.6%) and 4(8.8%) patients developed bleeding episode, sepsis and MODS respectively. ANOVA test suggested that decreased creatinine clearance rate was significantly related to poor clinical outcome(P<0.05).Conclusion: This study showed that decreased creatinine clearance is directly related to poor outcome of acute coronary syndrome. So subjects with ACS should be closely monitored for decreased creatinine clearance rate to avoid life threatening complications. And subjects with renal impairment suffering from ACS should be closely observed as patients with decreased CCR has poor clinical outcome.Bangladesh Crit Care J March 2015; 3 (1): 3-6
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Saha et al. (2015) conducted an observational in Acute coronary syndrome (n=100). Decreased creatinine clearance rate (<60 ml/min) vs. Normal creatinine clearance rate (>60 ml/min) was evaluated on In-hospital death (p=0.001). Decreased admission creatinine clearance rate (<30 ml/min) in patients with acute coronary syndrome was significantly associated with higher in-hospital mortality (8.8% vs 0%, p=0.001) compared to normal clearance.
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