[Prognostic value of glomerular filtrate in acute coronary syndrome: Cockcroft's index or MDRD equation?]

Abstract

Background and objectives: One third of patients with a coronary event show kidney failure. Our aim is to establish the relationship between kidney failure and mortality in patients diagnosed of acute coronary syndrome (ACS) through Cockcroft Index (C-G) and MDRD-4 equation, analyzing which of them is better for prognostic stratification.

Patients and method: Prospective study of 445 patients admitted consecutively between 2006 and 2007 with a high risk of ACS, dividing the sample depending on his kidney function at admission in < 60 mL/min/1.73 m(2) and > or =60 mL/min/1.73 m(2) through C-G and Modification of Diet in Renal Disease study group 4 (MDRD-4) and other variables. We performed a multivariate logistic regression for both of them, analysing the relationship with mortality in the following six months after admission.

Results: Renal failure was present in 27.9% (creatinine < 1.1mg/dl); 30.5% (C-G) and 22.6% (MDRD-4). Glomerular filtration (GF) was 81.6+/-35.2 mL/min (C-G) and 77.2+/-26.1 mL/min/1.73 m(2) (MDRD-4). Patients with GF < 60 mL/min showed high mortality, Odds ratio 2.652; p=0.024 (IC 95%, 1.140-6.166) for C-G and 3.372; p=0.001 (IC 95%, 1.637-6.954) for MDRD-4.

Conclusion: Renal failure increases the risk to die in the following six months after an ACS. The estimation through Cockcroft Index and/or MDRD-4 equation depends on the population characteristics and is indifferent with GF between 60 and 80 mL/min.