Creatinine clearance and adverse hospital outcomes in patients with acute coronary syndromes: findings from the global registry of acute coronary events (GRACE).

OBJECTIVE: To determine whether creatinine clearance at the time of hospital admission is an independent predictor of hospital mortality and adverse outcomes in patients with acute coronary syndromes (ACS). DESIGN: A prospective multicentre observational study, GRACE (global registry of acute coronary events), of patients with the full spectrum of ACS. SETTING: Ninety four hospitals of varying size and capability in 14 countries across four continents. PATIENTS: 11 774 patients hospitalised with ACS, including ST and non-ST segment elevation acute myocardial infarction and unstable angina. MAIN OUTCOME MEASURES: Demographic and clinical characteristics, medication use, and in-hospital outcomes were compared for patients with creatinine clearance rates of > 60 ml/min (normal and minimally impaired renal function), 30-60 ml/min (moderate renal dysfunction), and < 30 ml/min (severe renal dysfunction). RESULTS: Patients with moderate or severe renal dysfunction were older, were more likely to be women, and presented to participating hospitals with more comorbidities than those with normal or minimally impaired renal function. In comparison with patients with normal or minimally impaired renal function, patients with moderate renal dysfunction were twice as likely to die (odds ratio 2.09, 95% confidence interval 1.55 to 2.81) and those with severe renal dysfunction almost four times more likely to die (odds ratio 3.71, 95% confidence interval 2.57 to 5.37) after adjustment for other potentially confounding variables. The risk of major bleeding episodes increased as renal function worsened. CONCLUSION: In patients with ACS, creatinine clearance is an important independent predictor of hospital death and major bleeding. These data reinforce the importance of increased surveillance efforts and use of targeted intervention strategies in patients with acute coronary disease complicated by renal dysfunction.

Derrame pleural quiloso bilateral asociado a tromboembolismo pulmonar / Bilateral chylothorax associated with pulmonary artery embolism

Se describe una paciente con quilotórax bilateral asociado a embolismo de la rama inferior de la arteria pulmonar derecha. Este derrame se desarrolló como resultado de incremento en las presiones venosas centrales. El tratamiento definitivo se logró con streptokinasa

Derrame pleural quiloso bilateral asociado a tromboembolismo pulmonar / Bilateral chylothorax associated with pulmonary artery embolism

Se describe una paciente con quilotórax bilateral asociado a embolismo de la rama inferior de la arteria pulmonar derecha. Este derrame se desarrolló como resultado de incremento en las presiones venosas centrales. El tratamiento definitivo se logró con streptokinasa (AU)