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. 2016 Dec 1;11(12):e0167166.
doi: 10.1371/journal.pone.0167166. eCollection 2016.

Incidence, Mortality and Positive Predictive Value of Type 1 Cardiorenal Syndrome in Acute Coronary Syndrome

Raquel Pimienta González  1 , Patricia Couto Comba  1 , Marcos Rodríguez Esteban  1 , José Juan Alemán Sánchez  2   3 , Julio Hernández Afonso  1 , María Del Cristo Rodríguez Pérez  2   3 , Itahisa Marcelino Rodríguez  2   3 , Buenaventura Brito Díaz  2   3 , Roberto Elosua  3   4 , Antonio Cabrera de León  2   3   5
Affiliations

Incidence, Mortality and Positive Predictive Value of Type 1 Cardiorenal Syndrome in Acute Coronary Syndrome

Raquel Pimienta González et al. PLoS One. .

Abstract

Objectives: To determine whether the risk of cardiovascular mortality associated with cardiorenal syndrome subtype 1 (CRS1) in patients who were hospitalized for acute coronary syndrome (ACS) was greater than the expected risk based on the sum of its components, to estimate the predictive value of CRS1, and to determine whether the severity of CRS1 worsens the prognosis.

Methods: Follow-up study of 1912 incident cases of ACS for 1 year after discharge. Cox regression models were estimated with time to event (in-hospital death, and readmission or death during the first year after discharge) as the dependent variable.

Results: The incidence of CRS1 was 9.2/1000 person-days of hospitalization (95% CI = 8.1-10.5), but these patients accounted for 56.6% (95% CI = 47.4-65.) of all mortality. The positive predictive value of CRS1 was 29.6% (95% CI = 23.9-36.0) for in-hospital death, and 51.4% (95% CI = 44.8-58.0) for readmission or death after discharge. The risk of in-hospital death from CRS1 (RR = 18.3; 95% CI = 6.3-53.2) was greater than the sum of risks associated with either acute heart failure (RR = 7.6; 95% CI = 1.8-31.8) or acute kidney injury (RR = 2.8; 95% CI = 0.9-8.8). The risk of events associated with CRS1 also increased with syndrome severity, reaching a RR of 10.6 (95% CI = 6.2-18.1) for in-hospital death at the highest severity level.

Conclusions: The effect of CRS1 on in-hospital mortality is greater than the sum of the effects associated with each of its components, and it increases with the severity of the syndrome. CRS1 accounted for more than half of all mortality, and its positive predictive value approached 30% in-hospital and 50% after discharge.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Survival curves, including confidence bands, for death during hospitalization for acute coronary syndrome in model A (Table 4).
Fig 1A: No AHF and no AKI (reference category); Fig 1B: AKI but no AHF; Fig 1C: AHF but no AKI; Fig 1D = CRS1.
See this image and copyright information in PMC

References

    1. McCullough PA, Kellum JA, Haase M, Müller C, Damman K, Murray PT, et al. Pathophysiology of the cardiorenal syndromes: executive summary from the eleventh consensus conference of the Acute Dialysis Quality Initiative (ADQI). Contrib Nephrol 2013;182:82–98. 10.1159/000349966 - DOI - PubMed
    1. Ronco C. Cardiorenal syndromes: definition and classification. Contrib Nephrol 2010;164:33–38. 10.1159/000313718 - DOI - PubMed
    1. Ronco C, Haapio M, House AA, Anavekar N, Bellomo R. Cardiorenal syndrome. J Am Coll Cardiol 2008;52:1527–1539. 10.1016/j.jacc.2008.07.051 - DOI - PubMed
    1. Eren Z, Ozveren O, Buvukoner E, Kaspar E, Degertekin M, Kantarci G. A Single-Centre Study of Acute Cardiorenal Syndrome: Incidence, Risk Factors and Consequences. Cardiorenal Med 2012;2:168–176. 10.1159/000337714 - DOI - PMC - PubMed
    1. Virzì GM, Clementi A, Brocca A, de Cal M, Vescovo G, Granata A, et al. The hemodynamic and nonhemodynamic crosstalk in cardiorenal syndrome type 1. Cardiorenal Med. 2014;4:103–12 10.1159/000362650 - DOI - PMC - PubMed

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