ABSTRACT
BACKGROUND: An estimated 11% of the population of the USA has chronic kidney disease. Cardiovascular morbidity and mortality are high among these individuals. We evaluated the impact of evidence-based, secondary preventive medications on the overall clinical outcome among this population. METHODS: We observed 2,627 consecutive patients admitted to our institution for acute coronary syndrome. The glomerular filtration rate was estimated by the four-component Modification of Diet in Renal Disease equation and the patients were stratified into groups on the basis of the guidelines of the National Kidney Foundation. Mortality and the composite event rate of death, myocardial infarction and stroke were assessed at six months. We evaluated the impact of evidence-based medications as an independent predictor of outcomes, using a logistic regression analysis. RESULTS- Patients with a relatively greater decline in the glomerular filtration rate had poorer outcomes, both in hospital and at six-month follow-up. Among those with stages III-V of chronic kidney disease, the use of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) was associated with 44% lower odds of death (95% CI: 0.14-0.63), as well as 40% lower odds of the composite end-point (95% CI: 0.13-0.59) at six months. CONCLUSION: Chronic kidney disease was independently associated with mortality and major adverse cardiovascular events in a hospital registry of consecutive patients with acute coronary syndrome. Our results add to the existing body of evidence that more appropriate use of evidence-based medications, particularly statins, may significantly improve clinical outcomes in these highndash;risk patients. We should aim to improve the quality of treatment options available to patients suffering from both conditions.
ABSTRACT
BACKGROUND, In patients with acute coronary syndrome, smoking cessation rates, demographics, and management strategies havenot been well described. We hypothesized that hospitalized patients with acute coronary syndrome would have higher smoking cessation rates than other currently available therapies. In-hospital counseling and referral to cardiac rehabilitation may further improve cessation rates. METHODS, We reviewed 1098 consecutive admissions for acute coronary syndrome at the University of Michigan; 254 of thesepatients reported active smoking status on admission. Patients were divided into (i) those who continued smoking and (ii) those who quit smoking based on a 6-month telephonic interview. Clinical variables, management and therapies were com-pared for the two cohorts. RESULTS, The mean age of the 254 patients was 56 years and 65% were male. At six months, 49.2% of patients had quit smok-ing. Significant predictors of smoking cessation were coronary artery bypass grafting, pulmonary artery catheter placement, and need for mechanical ventilation. Patients who underwent cardiac rehabilitation post-discharge had a trendtoward higher cessation rates. Formal counseling during hospitalization did not seem to affect cessation rates. CONCLUSIONS, In this study, patients with acute coronary syndrome had a higher 6-month smoking cessation rate than previously published rates seen in ambulatory practice, and the more severely ill patients had higher cessation rates. Smoking cessation rates were not higher in those who received in-patient smoking counseling.