Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Murcia, Spain.
Department of Cardiology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain.
J Am Heart Assoc. 2018 Apr 21;7(9):e008725. doi: 10.1161/JAHA.118.008725.
A simple method to assess renal function is the estimated glomerular filtration rate, and it shows prognostic implications. However, it remains unknown which equation should be used in patients with acute coronary syndrome. We compared the ability and correlation of the Cockcroft-Gault, Modification of Diet in Renal Disease-4 (MDRD-4), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations and their predictive performance for major adverse cardiovascular events, all-cause mortality, and major bleeding in a cohort of patients with acute coronary syndrome.
Multicenter prospective registry involving 1699 consecutive patients with acute coronary syndrome from 3 tertiary institutions. At entry, renal function was assessed using the Cockcroft-Gault, MDRD-4, and CKD-EPI-creatinine equations. During 12 months of follow-up, we recorded all major adverse cardiovascular events (composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal ischemic stroke), bleeding events (Bleeding Academic Research Consortium classification), and all-cause mortality. Receiver operating characteristic curve comparisons demonstrated that Cockcroft-Gault equation had higher predictive ability compared with MDRD-4 equation for major adverse cardiovascular events (0.651 versus 0.616; =0.023), major bleeding (0.600 versus 0.551; =0.005), and all-cause mortality (0.754 versus 0.717; =0.033), as well as higher predictive ability compared with CKD-EPI equation for major bleeding (0.600 versus 0.564; =0.018). Integrated discrimination improvement and net reclassification improvement analyses showed superior discrimination and reclassification of Cockcroft-Gault equation. Decision curve analyses graphically demonstrated higher net benefit and clinical usefulness of the Cockcroft-Gault equation in comparison with MDRD-4 and CKD-EPI equations.
In patients with acute coronary syndrome, the Cockcroft-Gault equation presented superior predictive ability for major adverse cardiovascular events, major bleeding, and all-cause mortality compared with MDRD-4 equation, and superior predictive ability for major bleeding compared with CKD-EPI equation. The Cockcroft-Gault equation also showed higher net benefit and clinical usefulness.
评估肾小球滤过率是一种简单的评估肾功能的方法，并且具有预后意义。然而，目前尚不清楚在急性冠状动脉综合征患者中应使用哪种方程。我们比较了 Cockcroft-Gault、肾脏病膳食改良试验-4（MDRD-4）和慢性肾脏病流行病学合作（CKD-EPI）方程在急性冠状动脉综合征患者中的能力和相关性，以及它们对主要不良心血管事件、全因死亡率和主要出血的预测性能。
多中心前瞻性队列研究纳入了来自 3 家三级医疗机构的 1699 例连续急性冠状动脉综合征患者。在入组时，使用 Cockcroft-Gault、MDRD-4 和 CKD-EPI-creatinine 方程评估肾功能。在 12 个月的随访期间，我们记录了所有主要不良心血管事件（心血管死亡、非致死性心肌梗死和非致死性缺血性卒中的复合终点）、出血事件（Bleeding Academic Research Consortium 分类）和全因死亡率。受试者工作特征曲线比较表明，Cockcroft-Gault 方程在预测主要不良心血管事件（0.651 比 0.616；=0.023）、主要出血（0.600 比 0.551；=0.005）和全因死亡率（0.754 比 0.717；=0.033）方面的预测能力高于 MDRD-4 方程，在预测主要出血方面的预测能力也高于 CKD-EPI 方程（0.600 比 0.564；=0.018）。综合判别改善和净重新分类改善分析表明，Cockcroft-Gault 方程的判别能力和重新分类能力更高。决策曲线分析图形地表明，与 MDRD-4 和 CKD-EPI 方程相比，Cockcroft-Gault 方程具有更高的净收益和临床实用性。
在急性冠状动脉综合征患者中，与 MDRD-4 方程相比，Cockcroft-Gault 方程在预测主要不良心血管事件、主要出血和全因死亡率方面具有更好的预测能力，在预测主要出血方面也具有更好的预测能力。Cockcroft-Gault 方程还显示出更高的净收益和临床实用性。
