Department of Internal Medicine C, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Department of Internal Medicine C, Meir Medical Center, Kfar Saba, Israel.
Eur J Intern Med. 2018 Jul;53:57-61. doi: 10.1016/j.ejim.2018.01.034. Epub 2018 Feb 13.
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.
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.
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.
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/1.73m 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/1.73m, 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/1.73m, respectively, p < 0.001).
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.
在综合内科病房，胸痛评估是导致住院的最常见原因之一。然而，对于急性冠状动脉综合征（ACS）排除后从综合内科病房出院的患者，其预后不良的预测因素知之甚少。
评估肾功能与 ACS 死亡率和住院率的相关性，这些患者在 ACS 排除后从综合内科病房出院。
纳入了在 2010 年至 2016 年期间因 ACS 被排除后从综合内科病房出院的患者。主要终点是出院后 30 天内全因死亡率和因 ACS 住院的复合终点。
本研究纳入了 12337 名患者，根据肾功能分为 3 组。将 eGFR≥60ml/min/1.73m 患者作为参考组，结果显示，随着 eGFR 的降低，30 天全因死亡率和因 ACS 住院的复合终点调整后的风险比增加（HR=2，95%CI=1.3-3.3，HR=4.8，95%CI=3-7.6，分别用于 eGFR 为 45-59.9 或 <45ml/min/1.73m 的患者，p<0.001）。同样，肾功能降低与 1 年全因死亡率增加相关（HR=1.6，95%CI=1.2-2.2，HR=4.5，95%CI=3.4-5.9，分别用于 eGFR 为 45-59.9 或 <45ml/min/1.73m 的患者，p<0.001）。
我们发现，在 ACS 排除后从综合内科病房出院的胸痛患者中，较低的 eGFR 与死亡和 ACS 风险之间存在独立的分级关联。eGFR 可能会被用于胸痛患者的风险分层。
