Nuccia Morici1, Stefano Savonitto2, Claudio Ponticelli3, Ilse C Schrieks4, Anna Nozza5, Francesco Cosentino6, Barbara E Stähli7, Pasquale Perrone Filardi8, Gregory G Schwartz9, Linda Mellbin6, A Michael Lincoff10, Jean-Claude Tardif11, Diederick E Grobbee4. 1. Unità di Terapia Intensiva Cardiologica, ASST Grande Ospedale Metropolitano Niguarda Ca' Granda, Milano, Italy. Electronic address: nuccia.morici@ospedaleniguarda.it. 2. Dipartimento Cardiovascolare, Ospedale A. Manzoni, Lecco, Italy. 3. Division of Nephrology, Humanitas Clinical Research Center, Rozzano (Milano), Italy. 4. Julius Center for Health Sciences and Primary Care and Julius Clinical, Utrecht, the Netherlands. 5. Montreal Health Innovations Coordinating Center, Quebec, Canada. 6. Cardiology Unit, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden. 7. Montreal Heart Institute, Université de Montréal, Quebec, Canada. 8. Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy. 9. Veterans Affairs Medical Center and University of Colorado School of Medicine, Denver. 10. Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Ohio. 11. Montreal Health Innovations Coordinating Center, Quebec, Canada; Montreal Heart Institute, Université de Montréal, Quebec, Canada.
Abstract
BACKGROUND:Worsening renal function during hospitalization for an acute coronary syndrome is strongly predictive of in-hospital and long-term outcome. However, the role of post-discharge worsening renal function has never been investigated in this setting. METHODS: We considered the placebo cohort of the AleCardio trial comparing aleglitazar with standard medical therapy among patients with type 2 diabetes mellitus and a recent acute coronary syndrome. Patients who had died or had been admitted to hospital for heart failure before the 6-month follow-up, as well as patients without complete renal function data, were excluded, leaving 2776 patients for the analysis. Worsening renal function was defined as a >20% reduction in estimated glomerular filtration rate from discharge to 6 months, or progression to macroalbuminuria. The Cox regression analysis was used to determine the prognostic impact of 6-month renal deterioration on the composite of all-cause death and hospitalization for heart failure. RESULTS:Worsening renal function occurred in 204 patients (7.34%). At a median follow-up of 2 years the estimated rates of death and hospitalization for heart failure per 100 person-years were 3.45 (95% confidence interval [CI], 2.46-6.36) for those with worsening renal function, versus 1.43 (95% CI, 1.14-1.79) for patients with stable renal function. At the adjusted analysis worsening renal function was associated with the composite endpoint (hazard ratio 2.65; 95% CI, 1.57-4.49; P <.001). CONCLUSIONS: Post-discharge worsening renal function is not infrequent among patients with type 2 diabetes and acute coronary syndromes with normal or mildly depressed renal function, and is a strong predictor of adverse cardiovascular events.
RCT Entities:
BACKGROUND: Worsening renal function during hospitalization for an acute coronary syndrome is strongly predictive of in-hospital and long-term outcome. However, the role of post-discharge worsening renal function has never been investigated in this setting. METHODS: We considered the placebo cohort of the AleCardio trial comparing aleglitazar with standard medical therapy among patients with type 2 diabetes mellitus and a recent acute coronary syndrome. Patients who had died or had been admitted to hospital for heart failure before the 6-month follow-up, as well as patients without complete renal function data, were excluded, leaving 2776 patients for the analysis. Worsening renal function was defined as a >20% reduction in estimated glomerular filtration rate from discharge to 6 months, or progression to macroalbuminuria. The Cox regression analysis was used to determine the prognostic impact of 6-month renal deterioration on the composite of all-cause death and hospitalization for heart failure. RESULTS: Worsening renal function occurred in 204 patients (7.34%). At a median follow-up of 2 years the estimated rates of death and hospitalization for heart failure per 100 person-years were 3.45 (95% confidence interval [CI], 2.46-6.36) for those with worsening renal function, versus 1.43 (95% CI, 1.14-1.79) for patients with stable renal function. At the adjusted analysis worsening renal function was associated with the composite endpoint (hazard ratio 2.65; 95% CI, 1.57-4.49; P <.001). CONCLUSIONS: Post-discharge worsening renal function is not infrequent among patients with type 2 diabetes and acute coronary syndromes with normal or mildly depressed renal function, and is a strong predictor of adverse cardiovascular events.