Restricted accessResearch articleFirst published online 2018-12
Prognostic comparison between creatinine-based glomerular filtration rate formulas for the prediction of 10-year outcome in patients with non-ST elevation acute coronary syndrome treated by percutaneous coronary intervention
Estimated glomerular filtration rate (eGFR) is a predictor of outcome among patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), but which estimation formula provides the best long-term risk stratification in this setting is still unclear. We compared the prognostic performance of four creatinine-based formulas for the prediction of 10-year outcome in a NSTE-ACS population treated by percutaneous coronary intervention.
Methods:
In 222 NSTE-ACS patients submitted to percutaneous coronary intervention, eGFR was calculated using four formulas: Cockcroft–Gault, re-expressed modification of diet in renal disease (MDRD), chronic kidney disease epidemiology collaboration (CKD-Epi), and Mayo-quadratic. Predefined endpoints were all-cause death and a composite of cardiovascular death, non-fatal reinfarction, clinically driven repeat revascularisation, and heart failure hospitalisation.
Results:
The different eGFR values showed poor agreement, with prevalences of renal dysfunction ranging from 14% to 35%. Over a median follow-up of 10.2 years, eGFR calculated by the CKD-Epi and Mayo-quadratic formulas independently predicted outcome, with an increase in the risk of death and events by up to 17% and 11%, respectively, for each decrement of 10 ml/min/1.73 m2. The Cockcroft–Gault and MDRD equations showed a borderline association with mortality and did not predict events. When compared in terms of goodness of fit, discrimination and calibration, the Mayo-quadratic outperformed the other formulas for the prediction of death and the CKD-Epi showed the best performance for the prediction of events (net reclassification improvement values 0.33–0.35).
Conclusions:
eGFR is an independent predictor of long-term outcome in patients with NSTE-ACS treated by percutaneous coronary intervention. The Mayo-quadratic and CKD-Epi equations might be superior to classic eGFR formulas for risk stratification in these patients.
GoASChertowGMDonjieFanChronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med2004; 351: 1296–1305.
2.
TonelliMWiebeNCulletonBChronic kidney disease and mortality risk: a systematic review. J Am Soc Nephrol2006; 17: 2034–2047.
3.
Al SuwaidiJReddanDNWilliamsKGUSTO-IIb, GUSTO-III, PURSUIT. Global use of strategies to open occluded coronary arteries: platelet glycoprotein IIb/IIIa in unstable angina: receptor suppression using integrilin therapy; PARAGON-A Investigators. Platelet IIb/IIIa antagonism for the reduction of acute coronary syndrome events in a global organization network. Prognostic implications of abnormalities in renal function in patients with acute coronary syndromes. Circulation2002; 106: 974–980.
4.
AnavekarNSMcMurrayJJVelazquezEJRelation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med2004; 351: 1285–1295.
5.
KümlerTGislasonGHKoberLRenal function at the time of a myocardial infarction maintains prognostic value for more than 10 years. BMC Cardiovasc Disord2011; 11: 37.
6.
SantopintoJJFoxKAGoldbergRJCreatinine clearance and adverse hospital outcomes in patients with acute coronary syndromes: findings from the Global Registry of Acute Coronary Events (GRACE). Heart2003; 89: 1003–1008.
7.
MelloniCCornelJHHafleyGImpact of chronic kidney disease on long-term ischemic and bleeding outcomes in medically managed patients with acute coronary syndromes: insights from the TRILOGY ACS Trial. Eur Heart J Acute Cardiovasc Care2016; 5: 443–454.
8.
LinTHHsinHTWangCLImpact of impaired glomerular filtration rate and revascularization strategy on one-year cardiovascular events in acute coronary syndrome: data from Taiwan acute coronary syndrome full spectrum registry. BMC Nephrol2014; 15: 66.
9.
Cabrerizo GarcíaJLZalba EtayoBPérez CalvoJI.Prognostic value of glomerular filtrate in acute coronary syndrome: Cockcroft’s index or MDRD equation?Med Clin2010; 134: 624–629.
10.
LiuYGaoLXueQImpact of renal dysfunction on long-term outcomes of elderly patients with acute coronary syndrome: a longitudinal, prospective observational study. BMC Nephrol2014; 15: 78.
11.
WongJAGoodmanSGYanRTTemporal management patterns and outcomes of non-ST elevation acute coronary syndromes in patients with kidney dysfunction. Eur Heart J2009; 30: 549–557.
12.
FoxCSMuntnerPChenAYUse of evidence-based therapies in short-term outcomes of ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction in patients with chronic kidney disease: a report from the National Cardiovascular Data Acute Coronary Treatment and Intervention Outcomes Network registry. Circulation2010; 121: 357–365.
13.
StegPhGGoldbergRJGoreJMBaseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE). Am J Cardiol2002; 90: 358–363.
14.
National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis2002; 39: S1–S266.
15.
FlorkowskiCMChew-HarrisJS.Methods of estimating GFR – different equations including CKD-EPI. Clin Biochem Rev2011; 32: 75–79.
16.
StevensPELevinA; Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med2013; 158: 825–830.
17.
National Clinical Guideline Centre (UK). Chronic kidney disease (partial update): early identification and management of chronic kidney disease in adults in primary and secondary care. London: National Institute for Health and Care Excellence (UK), 2014.
18.
AmsterdamEAWengerNKBrindisRG; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons; American Association for Clinical Chemistry. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol2014; 64: e139–e228.
19.
RoffiMPatronoCColletJP2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J2016; 37: 267–315.
20.
LevineGNBatesERBlankenshipJC2011 ACCF/AHA/SCAI Guideline for percutaneous coronary intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation2011;124: e574–e651.
LanskyAJGotoKCristeaEClinical and angiographic predictors of short- and long-term ischemic events in acute coronary syndromes: results from the Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) trial. Circ Cardiovasc Interv2010; 3: 308–316.
23.
WangHTChenYLWuCJ.Impact of chronic kidney disease on clinical outcomes in patients with non-ST elevation myocardial infarction receiving percutaneous coronary intervention – a five-year observational study. Int J Cardiol2016; 220: 166–172.
24.
MelloniCPetersonEDChenAYCockcroft–Gault versus modification of diet in renal disease: importance of glomerular filtration rate formula for classification of chronic kidney disease in patients with non-ST-segment elevation acute coronary syndromes. J Am Coll Cardiol2008; 51: 991–996.
25.
SpinlerSAMahaffeyKWGallupD; SYNERGY Trial Investigators. Relationship between renal function and outcomes in high-risk patients with non-ST-segment elevation acute coronary syndromes: results from SYNERGY. Int J Cardiol2010; 144: 36–41.
26.
GoldenbergISubiranaIBoykoVRelation between renal function and outcomes in patients with non-ST-segment elevation acute coronary syndrome: real-world data from the European Public Health Outcome Research and Indicators Collection Project. Arch Intern Med2010; 170: 888–895.
27.
FischerMJHoPMMcDermottKChronic kidney disease is associated with adverse outcomes among elderly patients taking clopidogrel after hospitalization for acute coronary syndrome. BMC Nephrol2013; 14: 107.
28.
AlFalehHFAlsuwaidaAOUllahAGlomerular filtration rate estimated by the CKD-EPI formula is a powerful predictor of in-hospital adverse clinical outcomes after an acute coronary syndrome. Angiology2012; 63: 119–126.
29.
AkerblomÅWallentinLSiegbahnACystatin C and estimated glomerular filtration rate as predictors for adverse outcome in patients with ST-elevation and non-ST-elevation acute coronary syndromes: results from the Platelet Inhibition and Patient Outcomes study. Clin Chem2012; 58: 190–199.
30.
BertrandMESimoonsMLFoxKA; Task Force on the Management of Acute Coronary Syndromes of the European Society of Cardiology. Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J2002; 23: 1809–1840.
31.
EagleKALimMJDabbousOH; GRACE Investigators. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. JAMA2004; 291: 2727–2733.
32.
CockcroftDWGaultMH.Prediction of creatinine clearance from serum creatinine. Nephron1976; 16: 31–41.
33.
LeveyASCoreshJGreeneTUsing standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med2006; 145: 247–254.
34.
LeveyASStevensLASchmidCH; CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med2009; 150: 604–612.
35.
RigalleauVLasseurCRaffaitinCThe Mayo Clinic quadratic equation improves the prediction of glomerular filtration rate in diabetic subjects. Nephrol Dial Transplant2007; 22: 813–818.
36.
HarjaiKJRaizadaAShenoyCA comparison of contemporary definitions of contrast nephropathy in patients undergoing percutaneous coronary intervention and a proposal for a novel nephropathy grading system. Am J Cardiol2008; 101: 812–819.
37.
KerrKFWangZJanesHNet reclassification indices for evaluating risk prediction instruments: a critical review. Epidemiology2014; 25: 114–121.
38.
BansalNHsuCYChandraMPotential role of differential medication use in explaining excess risk of cardiovascular events and death associated with chronic kidney disease: a cohort study. BMC Nephrol2011; 12: 44.
39.
KotwalSRanasingheIBriegerDThe influence of chronic kidney disease and age on revascularization rates and outcomes in acute myocardial infarction – a cohort study. Eur Heart J Acute Cardiovasc Care. Epub ahead of print 17March2016. DOI: 10.1177/2048872616640995.
40.
KontosMCJamalSMOrnatoJPComparison of the modification of diet in renal disease and the Cockcroft–Gault equations for predicting mortality in patients admitted for exclusion of myocardial ischemia. Am J Cardiol2008; 102: 140–145.
41.
SzummerKLundmanPJacobsonSH; SWEDEHEART. Cockcroft–Gault is better than the Modification of Diet in Renal Disease study formula at predicting outcome after a myocardial infarction: data from the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART). Am Heart J2010; 159: 979–986.
42.
AlmeidaICaetanoFBarraSEstimating glomerular filtration rate in acute coronary syndromes: different equations, different mortality risk prediction. Eur Heart J Acute Cardiovasc Care2016; 5: 223–230.
43.
Flores-BlancoPJLópez-CuencaÁComparison of risk prediction with the CKD-EPI and MDRD equations in non-ST-segment elevation acute coronary syndrome. Clin Cardiol2016; 39: 507–515.
44.
Abu-AssiELearPCabanas-GrandíoPA comparison of the CKD-EPI, MDRD-4, and Cockcroft–Gault equations to assess renal function in predicting all-cause mortality in acute coronary syndrome patients. Int J Cardiol2013; 167: 2325–2326.
45.
OrvinKEisenAGoldenbergIThe proxy of renal function that most accurately predicts short- and long-term outcome after acute coronary syndrome. Am Heart J2015; 169: 702–712. e3.
46.
WashamJBHerzogCABeitelsheesAL; American Heart Association Clinical Pharmacology Committee of the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, Council on Functional Genomics and Translational Biology, Council on the Kidney in Cardiovascular Disease, and Council on Quality of Care and Outcomes Research. Pharmacotherapy in chronic kidney disease patients presenting with acute coronary syndrome: a scientific statement from the American Heart Association. Circulation2015; 131: 1123–1149.
47.
Cabanas-GrandíoPAbu-AssiERaposeiras-RoubinSRelative performance of three formulas to assess renal function at predicting in-hospital hemorrhagic complications in an acute coronary syndrome population. What does the new CKD-EPI formula provide?Eur Heart J Acute Cardiovasc Care2014; 3: 237–245.
48.
TonelliMMuntnerPLloydAImpact of age on the association between CKD and the risk of future coronary events. Am J Kidney Dis2014; 64: 375–382.
49.
KajimotoKSatoNTakanoT; investigators of the Acute Decompensated Heart Failure Syndromes (ATTEND) registry. Association of anemia and renal dysfunction with in-hospital mortality among patients hospitalized for acute heart failure syndromes with preserved or reduced ejection fraction. Eur Heart J Acute Cardiovasc Care. Epub ahead of print 29June2015. DOI: 10.1177/2048872615593387.
50.
D’AscenzoFMorettiCBiancoMMeta-analysis of the duration of dual antiplatelet therapy in patients treated with second-generation drug-eluting stents. Am J Cardiol2016; 117: 1714–1723.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
