28 Feb MAYO Formula May Be Better Predictor of Mortality in Kidney Disease Patients With Acute Coronary Syndrome
MedicalResearch.com Interview with:
Alon Eisen, MD
Cardiology Department Rabin Medical Center
Petah Tikva Israel
Research Fellow in Medicine
Brigham and Women’s Hospital
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Elsen: It is well established that renal dysfunction is associated with worse prognosis among patients with acute coronary syndromes (ACS). Although there are several formulas to estimate glomerular filtration rate (eGFR), as a proxy of renal function, data regarding risk stratification in ACS patients using the different formulas remain incomplete. In this study, we aimed to determine the risk implications of five different eGFR formulas in a contemporary nation- wide cohort of consecutive ACS patients and to investigate which formula better predicts mortality in these patients.
Our study revealed several findings.
First, despite the significant and strong correlation between creatinine clearance or eGFR values using all five formulas, the proportion of patients categorized into the different renal function groups varied considerably, depending on the formula used. The choice of formula used influenced the stratification of patients into the different renal function categories, including the dichotomous distinction of significant versus non-significant renal dysfunction (eGFR<60 ml/min per 1.73 m²).
Second, as prior studies, we demonstrated an increased mortality among ACS patients with renal dysfunction.
Third, although the trend for increased mortality with worse renal function was demonstrated for all formulas, the absolute mortality rates varied considerably for each renal function category using the different formulas.
Last, although creatinine clearance or eGFR were found to be an independent predictor for short-term and long-term mortality using all five formulas, only the MAYO formula had better accuracy in predicting mortality relative to the MDRD, suggesting that it may be a better prognosticator among ACS patients.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Elsen: Although MDRD, CG, and CKD-EPI are most commonly used by clinicians to calculate eGFR or creatinine clearance, currently there are sparse data regarding the ability of eGFR formulas to predict clinical outcomes in patients with ACS. Our study emphasizes that although there is a variability between different eGFR formulas used in clinical practice, mortality in ACS patients increases as renal function worsens, regardless of the formula used and in all renal function categories. Furthermore, there is a substantial group of patients whose renal function is “discordant”, meaning that they have renal dysfunction according to some eGFR formulas but no renal dysfunction according to other formulas. As shown, these patients have worse outcomes, as compared to patients without renal dysfunction according to all eGFR formulas. Although it is beyond the scope of our study, we believe that these patients, as well as all other patients with renal dysfunction, should be treated by the best available guidelines recommended therapies.
Finally, we have aimed to answer the question which eGFR formula best assesses risk in ACS patients, and although we have demonstrated that only the MAYO formula had better accuracy in predicting mortality relative to the MDRD, this finding deserves further validation in future studies.
Katia Orvin, Alon Eisen, Ilan Goldenberg, Ateret Farkash, Nir Shlomo, Natalie Gevrielov-Yusim, Zaza Iakobishvili, David Hasdai
American Heart Journal February 23 2015
http://dx.doi.org/10.1016/j.ahj.2015.01.012
MedicalResearch.com Interview with: Alon Eisen, MD, Cardiology Department Rabin Medical Cente Petah Tikva Israel (2015). MAYO Formula May Be Better Predictor of Mortality in Kidney Disease Patients With Acute Coronary Syndrome
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Last Updated on March 1, 2015 by Marie Benz MD FAAD