Comparison of Risk Prediction With the CKD-EPI and MDRD Equations in Non-ST-Segment Elevation Acute Coronary Syndrome.


Journal Article

BACKGROUND: Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations estimate glomerular filtration rate (GFR) more accurately than the Modification of Diet in Renal Disease (MDRD) equation. HYPOTHESIS: New CKD-EPI equations improve risk stratification in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and provide complementary information to the Global Registry of Acute Coronary Events (GRACE) risk score. METHODS: We studied 350 subjects (mean age, 68 ± 12 years; 70% male) with NSTE-ACS. Estimated GFR was calculated using the MDRD and new CKD-EPI equations based on serum creatinine (SCr) and/or cystatin C (CysC) concentrations obtained within 48 hours of hospital admission. The primary endpoint was all-cause death during follow-up. RESULTS: Over the study period (median, 648 days [interquartile range, 236-1042 days]), 31 patients died (0.05% events per person-year). Decedents had poorer renal-function parameters (P < 0.001). Both CysC-based CKD-EPI equations had the highest areas under the receiver operating characteristic curve for the prediction of all-cause mortality. After multivariate adjustment, only CysC-based CKD-EPI equations were independent predictors of all-cause mortality (CKD-EPISCr - CysC , per mL/min/1.73 m(2) : hazard ratio: 0.975, 95% confidence interval: 0.956-0.994, P = 0.009; CKD-EPICysC , per mL/min/1.73 m(2) : hazard ratio: 0.976, 95% confidence interval: 0.959-0.993, P = 0.005). Reclassification analyses showed that only CysC-based CKD-EPI equations improved predictive accuracy of the GRACE risk score. CONCLUSIONS: In patients with NSTE-ACS, CysC-based CKD-EPI equations improved clinical risk stratification for mortality and added complementary prognostic information to the GRACE risk score.

Full Text

Duke Authors

Cited Authors

  • Flores-Blanco, PJ; López-Cuenca, Á; Januzzi, JL; Marín, F; Sánchez-Martínez, M; Quintana-Giner, M; Romero-Aniorte, AI; Valdés, M; Manzano-Fernández, S

Published Date

  • September 2016

Published In

Volume / Issue

  • 39 / 9

Start / End Page

  • 507 - 515

PubMed ID

  • 27249221

Pubmed Central ID

  • 27249221

Electronic International Standard Serial Number (EISSN)

  • 1932-8737

Digital Object Identifier (DOI)

  • 10.1002/clc.22556


  • eng

Conference Location

  • United States