Impact of renal dysfunction on acute coronary syndrome evaluation in observation unit patients.
Abstract
OBJECTIVES: The impact of renal disease on risk stratification of patients at low
risk for potential acute coronary syndrome has not been well defined. The objective
of this study was to document the prevalence of renal dysfunction and assess the association
between renal impairment and abnormal cardiac evaluation in observation unit (OU)
patients. METHODS: Retrospective cohort study at an academic medical center OU. Data
were abstracted using predetermined definitions of data outcomes by trained abstractors.
Patients had symptoms consistent with acute coronary syndrome and did not have obvious
evidence of acute MI or ischemia on electrocardiogram, unstable vital signs, abnormal
cardiac markers, serious arrhythmias, or uncontrollable chest pain. Observation patients
received serial cardiac markers and electrocardiograms, with the majority receiving
stress testing at treating physician discretion. Patients were stratified by glomerular
filtration rates (GFR) at cut-off points of less than 60 and less than 90 mL/min per
1.73 m(2). Odds ratios were calculated for stress test findings of inducible ischemia
or hospital admission. RESULTS: Five hundred and twenty-nine out of 545 patients had
complete data and were enrolled. Sixty-nine (13%) patients had a GFR of less than
60 and 300 (56%) patients had a GFR of less than 90. An abnormal cardiac evaluation
was found in 64 (12%) patients, of whom 31 (49%) had some renal impairment. The odds
ratio of an abnormal cardiac evaluation with a GFR of less than 90 is 1.65 (95% confidence
interval, 0.95-2.88) and 1.65 (95% confidence interval, 0.83-3.28) for GFR less than
60. CONCLUSIONS: Renal dysfunction is common in OU patients. In these patients, renal
dysfunction did not confer higher risk for abnormal cardiac evaluation.
Type
Journal articleSubject
Acute Coronary SyndromeAdult
Cohort Studies
Emergency Service, Hospital
Female
Glomerular Filtration Rate
Hospital Units
Hospitalization
Humans
Male
Middle Aged
Prevalence
Renal Insufficiency, Chronic
Retrospective Studies
Risk Factors
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https://hdl.handle.net/10161/12524Published Version (Please cite this version)
10.1016/j.ajem.2009.02.014Publication Info
Limkakeng, Alexander T; & Chandra, Abhinav (2010). Impact of renal dysfunction on acute coronary syndrome evaluation in observation unit
patients. Am J Emerg Med, 28(6). pp. 658-662. 10.1016/j.ajem.2009.02.014. Retrieved from https://hdl.handle.net/10161/12524.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Alexander Tan Limkakeng Jr.
Professor of Emergency Medicine
My personal research interest is finding new ways to diagnose acute coronary syndrome.
In particular, I am interested in novel biomarkers and precision medicine approaches
to this problem. I also have an interest in sepsis and empirical bioethics. As Vice
Chair of Clinical Research for the Duke University Department of Emergency Medicine,
I also work with researchers from many fields spanning global health, innovation,
clinical trials, basic discovery, and trans

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