Acute decline in renal function, inflammation, and cardiovascular risk after an acute coronary syndrome.

Journal Article (Journal Article)

BACKGROUND AND OBJECTIVES: Chronic kidney disease is associated with a higher risk of cardiovascular outcomes. The prognostic significance of worsening renal function has also been shown in various cohorts of cardiac disease; however, the predictors of worsening renal function and the contribution of inflammation remains to be established. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Worsening renal function was defined as a 25% or more decrease in estimated GFR (eGFR) over a 1-mo period in patients after a non-ST or ST elevation acute coronary syndromes participating in the Aggrastat-to-Zocor Trial; this occurred in 5% of the 3795 participants. RESULTS: A baseline C-reactive protein (CRP) in the fourth quartile was a significant predictor of developing worsening renal function (odds ratio, 2.48; 95% confidence interval, 1.49, 4.14). After adjusting for baseline CRP and eGFR, worsening renal function remained a strong multivariate predictor for the combined cardiovascular composite of CV death, recurrent myocardial infarction (MI), heart failure or stroke (hazard ratio, 1.6; 95% confidence interval, 1.1, 2.3). CONCLUSIONS: Patients with an early decline in renal function after an acute coronary syndrome are at a significant increased risk for recurrent cardiovascular events. CRP is an independent predictor for subsequent decline in renal function and reinforces the idea that inflammation may be related to the pathophysiology of progressive renal disease.

Full Text

Duke Authors

Cited Authors

  • Mielniczuk, LM; Pfeffer, MA; Lewis, EF; Blazing, MA; de Lemos, JA; Mohanavelu, S; Rouleau, J; Fox, K; Pedersen, TR; Califf, RM

Published Date

  • November 2009

Published In

Volume / Issue

  • 4 / 11

Start / End Page

  • 1811 - 1817

PubMed ID

  • 19820133

Pubmed Central ID

  • PMC2774965

Electronic International Standard Serial Number (EISSN)

  • 1555-905X

Digital Object Identifier (DOI)

  • 10.2215/CJN.03510509


  • eng

Conference Location

  • United States