Unlocking the Impact of Renal Function on Acute Coronary Syndrome: Insights from A Cohort Of 318 Cases

Introduction: Chronic kidney disease (CKD) represents a distinct risk factor by itself for the development of coronary artery disease (CAD). Notably, CAD stands as the primary driver of both sickness and death among individuals diagnosed with CKD. Furthermore, individuals with CKD tend to experience worse outcomes when it comes to CAD. In addition to conventional risk factors, numerous factors associated with uremia, including inflammation, oxidative stress, endothelial dysfunction, coronary artery calcification, elevated homocysteine levels, and the use of immunosuppressants, have been linked to an increased risk of accelerated atherosclerosis. Objective and method: In this study, we aim to assess the differential effect of renal impairment across the spectrum of patients with acute coronary syndrom. We conducted this study in the intensive care unit of cardiology in the Military Teaching Hospital of Rabat. Results: A total of 318 patients were included in the study. The average age was 63.8 +/- 9.41 years and 77% (244/318) were male. Normal kidney function was reported in 72.8% (220/318) of patients. Of the 318 included patients, 121(38.3%) were presented with STEMI, 154 (48.7%) with NSTEMI, and 41 (13%) with unstable angina. The difference of age was significant with a p-value of <.001 with a mean of age of 61.8 in patients with normal renal function vs 68.1 in impaired renal function patients. Patients with impaired GFR had more history of previous PCI (21) compared to those with normal GFR (23) with a p value of 0.001. Hb was lower (12.5vs 13.9 p<0.01) and Grace score was higher (45 vs44 p<.001) in patients with impaired GFR vs patients with normal GFR. Percentage of cardiogenic shock and death was respectively higher in renal impairment (12(60%) vs 8 (40%) with p of 0.004); (10(62.5%) vs 6(37.5%) with p 0.005. Conclusion: The magnitude of renal impairment is significant in our study in the most deadly complication: cardiogenic shock and death; which confirms that outcomes of coronary artery disease especially in acute coronary syndrome are significantly poorer in patient with kidney disease.