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  2. Vol 55, No 1 (2023)
  3. Ginanjar

Factors Associated with 30-day Major Adverse Cardiovascular Event in Acute Coronary Syndrome Patients with Non-Dialysis Chronic Kidney Disease: A Retrospective Cohort Study

Eka Ginanjar, Ni Made Hustrini, Arif Mansjoer, M Shiddiq Al Hanif

Abstract


Background: Acute coronary syndrome (ACS) accounts for the majority of ischemic heart disease-related deaths. It is known that ACS patients with chronic kidney disease (CKD) tend to have worse clinical outcomes, including major adverse coronary events (MACE) compared to patients without CKD.  Some studies suggested that several determinant factors may be involved in this condition. Until now, research on determinant factors of MACE in ACS patients with CKD in Indonesia is still limited. Thus, we aimed to investigate the relationship of various factors to MACE in ACS patients with non-dialysis CKD who underwent percutaneous coronary intervention (PCI), in the form of neutrophile leukocyte ratio (NLR) as a factor describing chronic inflammation, left ventricular hypertrophy (LVH) as a factor describing cardiac remodeling, Gensini score may represent coronary severity, whereas GRACE was used to evaluate the severity and clinical risk of ACS patients. Methods: This study is a retrospective cohort study using secondary data from the medical records of 117 ACS patients who underwent percutaneous coronary intervention (PCI) at Cipto Mangunkusumo General Hospital Jakarta from January 2018 to June 2018 . Patients were classified based on the stage of CKD and assessed for 30-day MACE. Data were recorded on GRACE score, Gensini score, LVH, and neutrophil-lymphocyte ratio (NLR). Analysis of the relationship between these factors was carried out using the chi-square test. Results: Of the 117 patients, 62.3% were STEMI. At the end of hospital treatment, 67.5% were in the normal-stage 2 CKD group, 17.1% in the CKD stage 3a-3b group, and 15.4% in the CKD stage 4-5 group. MACE occurred in 47 (40.2%) patients with 17 (14.5%) dying. There was a significant relationship between GRACE scores and MACE (54.8% MACE at high GRACE scores vs. 32% MACE at low-moderate GRACE scores, p = 0.016, OR: 2,57 CI 95%, 1,18-5,59), while no significant relationship was found for the Gensini score, LVH, and NLR scores even though there was an increase in the proportion of MACE. Conclusion: The incidence of MACE is higher than in the previous studies conducted in the same place, i.e. Cipto Mangunkusumo General Hospital, no significant relationship is found in NLR, LVH, and Gensini score with the 30-day MACE of ACS patients with non-dialysis CKD, meanwhile the GRACE score correlates with the 30-day MACE of ACS in non-dialysis CKD patients as is the known theory regarding this score.

Keywords


ACS; CKD; MACE; GRACE score; Gensini score; LVH; NLR

References


Bueno H. Epidemiology of acute coronary syndromes - Oxford Medicine. Oxford University Press [Internet]. 2018 [cited 2021 Sep 22]; Available from: https://oxfordmedicine.com/view/10.1093/med/9780198784906.001.0001/med-9780198784906-chapter-305

Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC Guideline for the management of patients with non–ST-elevation acute coronary syndromes. Circulation. 2014;130:e344–426.

Kementerian Kesehatan RI. Report of national basic health research 2018. [Hasil Utama RISKESDAS 2018] [Internet]. 2018 [cited 2021 Sep 22]. Available from: https://kesmas.kemkes.go.id/assets/upload/dir_519d41d8cd98f00/files/Hasil-riskesdas-2018_1274.pdf,

United States Renal Data System (US). 2020 USRDS Annual data report: Epidemiology of kidney disease in the United States. [Internet]. Data report: Epidemiology of kidney disease in the United States. National. [cited 2022 Apr 18]. Available from: https://adr.usrds.org/

Indonesian Society of Nephrology. 10th report of Indonesian renal registry. 2018. p. 46.

Sarnak MJ, Amann K, Bangalore S, et al. Chronic kidney disease and coronary artery disease: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019;74(14):1823–38.

Poudel I, Tejpal C, Rashid H, Jahan N. Major adverse cardiovascular events: An inevitable outcome of ST-elevation myocardial infarction? A Literature Review. Cureus. 2019;11(7):e5280.

Wei X, Zhang Y, Yan G, Wang X. The relationship between chronic kidney disease and the severity and long-term prognosis of patients with coronary artery disease after drug-eluting stent implantation. Int J Gen Med. 2021;14:399–404.

Liu Y, Gao L, Xue Q, et al. Impact of renal dysfunction on long-term outcomes of elderly patients with acute coronary syndrome: a longitudinal, prospective observational study. BMC Nephrology. 2014;15(1):78.

Amighi J, Hoke M, Mlekusch W, et al. Beta 2 microglobulin and the risk for cardiovascular events in patients with asymptomatic carotid atherosclerosis. Stroke. 2011;42(7):1826–33.

Yoshitomi R, Nakayama M, Sakoh T, et al. High neutrophil/lymphocyte ratio is associated with poor renal outcomes in Japanese patients with chronic kidney disease. Ren Fail. 2019;41(1):238–43.

Izumaru K, Hata J, Nakano T, et al. Reduced estimated GFR and cardiac remodeling: A population-based autopsy study. Am J Kidney Dis. 2019;74(3):373–81.

Di Lullo L, Gorini A, Russo D, Santoboni A, Ronco C. Left ventricular hypertrophy in chronic kidney disease patients: From pathophysiology to treatment. Cardiorenal Med. 2015;5(4):254–66.

Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol. 1983 Feb;51(3):606.

Kim IY, Hwang IH, Lee KN, et al. Decreased renal function is an independent predictor of severity of coronary artery disease: An application of Gensini score. J Korean Med Sci. 2013;28(11):1615–21.

Cai Q, Mukku VK, Ahmad M. Coronary artery disease in patients with chronic kidney disease: A clinical update. Curr Cardiol Rev. 2013;9(4):331–9.

Coyle M, Flaherty G, Jennings C. A critical review of chronic kidney disease as a risk factor for coronary artery disease. Int J Cardiol Heart Vasc. 2021;35:100822.

Ginanjar E, Alwi I, Lydia A, et al. The association of β2-microglobulin and fibroblast growth factor 23 with major adverse cardiac event in acute coronary syndrome patients with chronic kidney disease. Acta Med Indones-Indones J Intern Med. 2021;53(1):5–12.

Collet JP, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The 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 J. 2021;42(14):1289–367.

National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1-266.

Martalena D. Effect of admission hyperglycemia on the survival of major adverse cardiac events in acute coronary syndrome patients during treatment at the ICCU RSCM [Pengaruh Hiperglikemia Admisi terhadap Major Adverse Cardiac Events Selama Perawatan pada Pasien Sindrom Koroner Akut di ICCU RSCM]. Jakarta. eJKI. 2013;1(2):106–12.

Darmawan A. Role of neutrophil lymphocyte ratio as major adverse cardiac events predictor in acute coronary syndrome during first seven days of hospitalization Peran [Rasio netrofil limfosit sebagai prediktor major adverse cardiac events tujuh hari dalam perawatan pada pasien sindrom koroner akut]. Universitas Indonesia Library. 2016 [cited 2022 Nov 18]. Available from: https://lib.ui.ac.id

Shah N, Parikh V, Patel N, et al. Neutrophil lymphocyte ratio significantly improves the Framingham risk score in prediction of coronary heart disease mortality: insights from the National Health and Nutrition Examination Survey-III. Int J Cardiol. 2014;171(3):390–7.

Han YC, Yang TH, Kim DI, et al. Neutrophil to lymphocyte ratio predicts long-term clinical outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Korean Circ J. 2013;43(2):93–9.

Foley RN, Parfrey PS, Harnett JD, Kent GM, Martin CJ, Murray DC, et al. Clinical and echocardiographic disease in patients starting end-stage renal disease therapy. Kidney Int. 1995;47(1):186–92.

Harnett JD, Parfrey PS, Griffiths SM, Gault MH, Barre P, Guttmann RD. Left ventricular hypertrophy in end-stage renal disease. Nephron. 1988;48(2):107–15.

Di Lullo L, Floccari F, Polito P. Right ventricular diastolic function in dialysis patients could be affected by vascular access. Nephron Clin Pract. 2011;118(3):c257-261.

Gross ML, Ritz E. Hypertrophy and fibrosis in the cardiomyopathy of uremia--beyond coronary heart disease. Semin Dial. 2008;21(4):308–18.

London GM, Pannier B, Guerin AP, et al. Alterations of left ventricular hypertrophy in and survival of patients receiving hemodialysis: follow-up of an interventional study. J Am Soc Nephrol. 2001;12(12):2759–67.

Zoccali C, Benedetto FA, Mallamaci F, et al. Left ventricular mass monitoring in the follow-up of dialysis patients: prognostic value of left ventricular hypertrophy progression. Kidney Int. 2004;65(4):1492–8.

Krane V, Winkler K, Drechsler C, et al. Effect of atorvastatin on inflammation and outcome in patients with type 2 diabetes mellitus on hemodialysis. Kidney International. 2008;74(11):1461–7.

Yildirim E, Iyisoy A, Celik M, et al. The relationship between Gensini score and in-hospital mortality in patients with ST-segment elevation myocardial infarction. Int J Cardiovasc Sci. 2017;30(1):32–41.

Ye Q, Zhang J, Ma L. Predictors of all-cause 1-year mortality in myocardial infarction patients. Medicine [Internet]. 2020;99(29). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373524/

Santopinto JJ, Fox KA, Goldberg RJ, et al. Creatinine clearance and adverse hospital outcomes in patients with acute coronary syndromes: findings from the global registry of acute coronary events (GRACE). Heart. 2003;89(9):1003–8.

Fu Y, Sun H, Guo Z, et al. A risk score model to predict in-hospital mortality of patients with end-stage renal disease and acute myocardial infarction. Intern Emerg Med. 2021;16(4):905–12.

Yagi H, Kawai M, Komukai K, et al. Impact of chronic kidney disease on the severity of initially diagnosed coronary artery disease and the patient prognosis in the Japanese population. Heart Vessels. 2011;26(4):370–8.


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