Relationship between renal function and outcomes in high-risk patients with non-ST-segment elevation acute coronary syndromes: results from SYNERGY.


Journal Article

BACKGROUND: Chronic kidney disease (CKD) is a risk factor for coronary heart disease and bleeding with antithrombotic therapy in patients with acute coronary syndromes (ACS). We evaluated the effect of renal function on efficacy and outcomes in high-risk patients with NSTE ACS in the SYNERGY trial. METHODS: Creatinine clearance (CrCl) at the time of randomization was analyzed as a continuous variable added to multivariable logistic regression models for 30-day death or MI, non-CABG-associated TIMI major bleeding, GUSTO severe bleeding, and transfusion in the overall study population, patients undergoing coronary angiography, and patients undergoing PCI. RESULTS: Of 9838 patients with a CrCl value, 70.6% (N=6950) had CrCl≥60 mL/min, 27.8% (N=2732) had CrCl 30-59 mL/min, and 1.6% (N=156) had CrCl<30 mL/min. No randomized treatment by CrCl interaction test was found to be statistically significant, suggesting renal insufficiency affected enoxaparin and unfractionated heparin outcomes similarly. After adjustment, CrCl was an independent predictor of 30-day death or MI (OR 1.06, 95% CI 1.03-1.09), TIMI major bleeding (OR 1.06, 95% CI 1.02-1.10), GUSTO severe bleeding (OR 1.10, 95% CI 1.03-1.17), and transfusion (OR 1.07, 95% CI 1.04-1.11). CONCLUSIONS: Patients with CKD had higher rates of 30-day death or MI and bleeding than those without CKD, regardless of randomized antithrombin therapy. While this analysis suggests that there is a rise in bleeding events as CrCl falls for patients in either treatment group, it is unknown whether a reduction in dose would decrease bleeding risk.

Full Text

Duke Authors

Cited Authors

  • Spinler, SA; Mahaffey, KW; Gallup, D; Levine, GN; Ferguson, JJ; Rao, SV; Gallo, R; Ducas, J; Goodman, SG; Antman, E; White, HD; Biasucci, L; Becker, RC; Col, JJ; Cohen, M; Harrington, RA; Califf, RM; SYNERGY Trial Investigators,

Published Date

  • September 24, 2010

Published In

Volume / Issue

  • 144 / 1

Start / End Page

  • 36 - 41

PubMed ID

  • 19406493

Pubmed Central ID

  • 19406493

Electronic International Standard Serial Number (EISSN)

  • 1874-1754

Digital Object Identifier (DOI)

  • 10.1016/j.ijcard.2009.03.119


  • eng

Conference Location

  • Netherlands