Highlights
- •Risk assessment of patients discharged following ACS rule-out remains a challenge.
- •We found that lower eGFR was associated with increased risk of death and ACS.
- •Estimated GFR may be combined in risk stratification of patients with chest pain.
Abstract
Background
Assessment of chest pain is one of the most common reasons for hospital admissions
in internal medicine wards. However, little is known regarding predictors for poor
prognosis in patients discharged from internal medicine wards after acute coronary
syndrome (ACS) rule-out.
Objective
To assess the association of kidney function with mortality and hospital admissions
due to ACS in patients with chest pain who were discharged from internal medicine
wards following ACS rule-out.
Methods
Included were patients admitted to an internal medicine ward who were subsequently
discharged following an ACSrule-out during 2010–2016. The primary endpoint was the
composite of all-cause mortality and hospital admission due to ACS at 30-days following
hospital discharge.
Results
Included in the study were12,337 patients who were divided into 3 groups according
to renal function. Considering patients with an eGFR ≥ 60 ml/min/1.73m2 as the reference group yielded adjusted hazard ratios for the composite of 30-day
all-cause mortality and hospital admission for ACS that increased with reduced eGFR
(HR = 2, 95%CI = 1.3–3.3, HR = 4.8, 95%CI = 3–7.6, for patients with eGFR of 45 to
59.9 or <45 ml/min/1.73m2, respectively, p < 0.001). Similarly, reduced renal function was associated with increased 1-year
all-cause mortality (HR = 1.6, 95%CI = 1.2–2.2, HR = 4.5, 95%CI = 3.4–5.9, for patients
with eGFR of 45–59.9 or <45 ml/min/1.73m2, respectively, p < 0.001).
Conclusion
We found an independent graded association between lower eGFR and the risk of death
and ACS among patients with chest pain who were discharged from internal medicine
wards following an ACS rule-out. The eGFR may be combined in the risk stratification
of patients with chest pain.
Keywords
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Article info
Publication history
Published online: February 05, 2018
Accepted:
January 31,
2018
Received in revised form:
January 6,
2018
Received:
August 16,
2017
Identification
Copyright
© 2018 Published by Elsevier B.V. on behalf of European Federation of Internal Medicine.
