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Renal function is a major prognostic determinant in patients with acute coronary syndrome (ACS). This study seeks to compare the clinical significance of two different estimated glomerular filtration rate (eGFR) equations, one of which is calculated by using the four-level race Chronic Kidney Disease Epidemiology Collaboration study equation (eGFREPI_4R) and the other is by using the Chinese modified Modification of Diet in Renal Disease study equation (eGFRcMDRD),in patients with ACS.
The patients admitted for ACS with elevated cardiac enzyme (Troponin-I) composed of this study. The equations of EPI_4R and cMDRD were used to calculate eGFR. National Death Registry was linked to identify the clinical outcomes of all-cause mortality within a 5-year follow-up.
Among a total of 2750 patients (age 71 ± 13 years, 78% men) in this study, 1175 patients (43%) received percutaneous coronary intervention (PCI) during admission. The calculations were generally higher by cMDRD than EPI_4R, especially in the patients with preserved renal function. During a median follow-up duration of 29 months, both eGFREPI_4R and eGFRcMDRD were independently predictive of mortality in the study population, after accounting for age, gender, systolic blood pressure, heart rate, peak Troponin-I level, shock status and intubation status (hazard ratio and 95% confidence intervals per-1SD: 0.528, 0.457-0.609 and 0.537, 0.463-0.623, respectively). The associations of eGFREPI_4R, eGFRcMDRD and clinical outcomes remained true whether or not the patients received PCI during admission. With reference to an eGFR of ≥90 ml/min/1.73 m2, advanced CKD stages defined by either equation were related to the incremental risks of mortality. Comparing to eGFRcMDRD, eGFREPI_4R was associated with a net reclassification improvement (NRI) of 2% (p=0.005) for predicting all-cause mortality in a total study population.
Both eGFRcMDRD and eGFREPI_4R equations were independently associated with total mortality in patients with ACS. Besides, eGFREPI_4R equation improved clinical risk stratification for total mortality compared to eGFRcMDRD equation.