Association of glomerular filtration rate on presentation with subsequent mortality in non-ST-segment elevation acute coronary syndrome; observations in 13307 patients in five TIMI trials

Authors:
  • RDRaphaelle L Dumaine
    Raphaelle L Dumaine
  • EGEli V Gelfand
    Eli V Gelfand
  • SMSabina A Murphy
    Sabina A Murphy
  • DMDavid A Morrow
    David A Morrow
  • SWStephen D Wiviott
    Stephen D Wiviott
  • CCChristopher P Cannon
    Christopher P Cannon
  • EAElliott M Antman
    Elliott M Antman
  • EBEugene Braunwald
    Eugene Braunwald
  • TGTIMI Study Group
    TIMI Study Group
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Abstract
To determine the association of glomerular filtration rate (GFR) with clinical outcomes in the setting of non-ST-segment elevation acute coronary syndromes (NSTE-ACS). Data were pooled from five NSTE-ACS TIMI trials (TIMI 11A and B, TIMI 12, OPUS-TIMI 16 and TACTICS-TIMI 18) and were available in 13 307 patients. GFR was assessed as a continuous and a categorical variable (normal: > or = 90 mL/min/1.73 m2, n=4952; mildly decreased: 60-89 mL/min/1.73 m2, n=6262; and moderately to severely decreased GFR: or = 5 (9.1% and 15.4%, respectively). Decreasing GFR was also independently associated with stroke and recurrent ischaemia at 30-days as well as with major bleeding (p<0.001). In the setting of NSTE-ACS, impaired GFR is associated with higher mortality as well as higher rates of thrombotic and major bleeding events, independent of TRS.