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European Heart Journal 2004 25(22):1998-2005; doi:10.1016/j.ehj.2004.08.016
Copyright © 2004 by the European Society of Cardiology.
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Clinical research

Association of glomerular filtration rate on presentation with subsequent mortality in non-ST-segment elevation acute coronary syndrome; observations in 13307 patients in five TIMI trials

C. Michael Gibson*, Raphaelle L. Dumaine, Eli V. Gelfand, Sabina A. Murphy, David A. Morrow, Stephen D. Wiviott, Robert P. Giugliano, Christopher P. Cannon, Elliott M. Antman and Eugene Braunwald For the TIMI Study Group

From the TIMI Study Group, Cardiovascular Division, Brigham & Women's Hospital and the Department of Medicine, Harvard Medical School, 350 Longwood Avenue, Boston, MA 02115, USA

Received April 2, 2004; revised August 13, 2004; accepted August 19, 2004 * Corresponding author. Tel.: +1 617 525 6884; fax: +1 888 249 5261 (E-mail: mgibson{at}timi.org).

AIMS: To determine the association of glomerular filtration rate (GFR) with clinical outcomes in the setting of non-ST-segment elevation acute coronary syndromes (NSTE-ACS).

METHODS AND RESULTS: Data were pooled from five NSTE-ACS TIMI trials (TIMI 11A and B, TIMI 12, OPUS-TIMI 16 and TACTICS-TIMI 18) and were available in 13 307 patients. GFR was assessed as a continuous and a categorical variable (normal: ⩾90 mL/min/1.73 m2, n=4952; mildly decreased: 60-89 mL/min/1.73 m2, n=6262; and moderately to severely decreased GFR: <60 mL/min/1.73 m2, n=2093). There was an independent association between decreasing GFR and mortality at 30 days (OR 1.19, 95% CI 1.12–1.27, p<0.001) and at 6 months (OR 1.16, 95% CI 1.11–1.22, p<0.001). The combination of TIMI risk score (TRS) and decreasing GFR provided further mortality risk stratification with highest 30-day and 6-month mortality rates among patients with the lowest GFR who also had a TRS⩾5 (9.1% and 15.4%, respectively). Decreasing GFR was also independently associated with stroke and recurrent ischaemia at 30-days as well as with major bleeding (p<0.001).

CONCLUSION: In the setting of NSTE-ACS, impaired GFR is associated with higher mortality as well as higher rates of thrombotic and major bleeding events, independent of TRS.


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