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07/07/2010 - General information

Kidney disease in patients with heart-related chest pain increases the mortality risk

The study was published in the journal Archives of Internal Medicine

According to an international study published in the journal Archives of Internal Medicine, which Jaume Marrugat, director of the IMIM Cardiovascular and Inflammatory Processes Research Programme, took part in along with other researchers of the Cardiovascular Genetics and Epidemiology Research Group, kidney disease is a significant predictor of in-hospital mortality and 30-day mortality in patients who come to the hospital with heart-related chest pain, otherwise known as Non-ST-segment Elevation Acute Coronary Syndrome (NSTE-ACS).

The study concludes that patients with NSTE-ACS and kidney disease have a mortality risk over two times higher than those patients not suffering from the associated kidney disease. However, those patients who, despite having both illnesses, have undergone a coronary angiograph, have a significantly lower mortality rate, even though it is still higher in comparison with those patients who do not have the associated kidney disease. According to Jaume Marrugat, it is believed that this is due to the fact that kidney disease usually associates itself with an accelerated atherosclerosis.

The study was carried out using 13,141 patients from three multinational registries, of which 32% had kidney disease. The in-hospital mortality rate of kidney disease patients was 5.4%, and 7.2% for the 30-day mortality rate. These rates were significantly higher than those observed in NSTE-ACS patients who didn’t have kidney disease. In contrast, kidney disease patients who had undergone an angiograph had a 36% lower in-hospital mortality risk and a 40% lower 30-day mortality risk. Nevertheless, both the in-hospital and 30-day mortality rates remained significantly higher than those observed in NSTE-ACS patients not suffering from kidney disease and who had also undergone an angiograph.

As a result of this finding, researchers recommend routinely requesting the glomerular filtrate in the analytical tests carried out on NSTE-ACS patients, because creatinine determination on its own may not be enough to detect some of these high risk patients. Similarly, the angiograph should be prescribed for all NSTE-ACS patients with kidney disease.

Just as is true for other patient sub-groups, treatment measures must be intensified in order to mitigate as much as possible the high death toll which this disease is responsible for (twice that of other patients). Researchers say that additional intense treatment measures are required, even after the angiograph, due to the high residual mortality risk in this population.

This research is opening up new lines in order to make progress in the etiological research on these illnesses and improve the survival of heart disease patients.

Reference Article:

Relation 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. Ilan Goldenberg, Isaac Subirana, Valentina Boyko, Joan Vila, Roberto Elosua, Gaieta Permanyer-Miralda, Ignacio Ferreira-González, Michal Benderly, Victor Guetta, Shlomo Behar, Jaume Marrugat, FESC. Arh Intern Med, Vol 170: 888-895.

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