The correlation of renal insufficiency and heartfailure in patients with acute coronary syndrome

Objective To investigate the relationship of renal insufficiency (RI) and heart failure (HF) in acute coronary syndrome (ACS) patients, the diagnosis and prognosis role of RI in HF patients stratified by left ventricular ejection fraction (LVEF). Methods A total of 2 014 patients were enrolled in Prognosis of patients with Acute Coronary Syndrome complicated with Renal Insufficiency (PACS-RI) registry. HF with preserved ejection fraction (HFpEF), mid-range ejection fraction (HFmrEF) and reduced ejection fraction (HFrEF) were defined as LVEF ≥50%, 40%-49% and 90, 60-90, 30-60 and<30 mL·min-1·1.73 m-2. Results Among patients with ACS, 757 patients (37.6%) had HF, of which 192 patients (9.5%) had HFrEF, 231 patients (11.5%) had HFmrEF and 334 patients (16.6%) had HFpEF. In HF patients, 373 (49.3%) had normal renal function, 165 (21.8%) had mild RI and 219 (28.9%) had moderate or severe RI. The lg N-terminal pro B-type natriuretic peptide (r=-0.211, P<0.01) and LVEF (r=0.113, P<0.01) levels were correlated with eGFR level. Prevalence of moderate or severe RI decreased gradually (34.9% vs. 30.3% vs. 24.6%, P<0.05) in HFrEF, HFmrEF and HFpEF groups. RI was confirmed to be a predictor for occurrence of HFrEF [odds ratio (OR) 3.148, 95% confidence interval (CI) 1.935-5.123, P<0.01], HFmrEF (OR 1.678, 95%CI1.133-2.485, P<0.05) or HFpEF (OR 1.402, 95%CI 1.020-1.927, P<0.05) in ACS patients. The OR (95%CI) for adverse in-hospital outcomes associated withRI in HFrEF, HFmrEF and HFpEF patients were 3.107 (1.051-9.185), 3.376 (1.440-7.915) and 3.635 (1.647-8.021), respectively. Conclusion RI and HF were closely related in ACS patients. RI could predict not only the occurrence of HF but also adverse in-hospital events for HFpEF, HFmrEF and HFrEF patients without significant difference. Key words: Acute coronary syndrome; Heart failure; Renal insufficiency; Left ventricular ejection fraction