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Acute coronary syndrome
Renal disease and acute coronary syndrome
  1. Petr Widimsky,
  2. Ivan Rychlik
  1. 3rd Faculty of Medicine, Charles University Prague, Czech Republic
  1. Correspondence to Professor Petr Widimsky, Cardiocenter, 3rd Faculty of Medicine, University Hospital Vinohrady, Srobarova 50, 100 34 Prague 10, Czech Republic; widim{at}fnkv.cz

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The wide implementation of invasive procedures such as coronary angiography and percutaneous coronary intervention (PCI) into the routine care for patients with acute coronary syndromes (ACS) in the last 10 years has caused a notable improvement in their prognosis. Simultaneously, it has raised new problems and questions which are largely related to the fact that many elderly and/or polymorbid patients undergo these invasive procedures. One of the most important comorbidities is chronic kidney disease (CKD). The complex relations between cardiac and renal disease are sometimes referred to as “cardiorenal syndrome” (table 1). We do not use this term clinically because we consider it misleading—it is not a real syndrome, but rather a chain of pathophysiologic events (in a similar way we could have cardiopulmonary syndrome, cardiocerebral syndrome, cardiohepatic syndrome, etc). Patients with CKD and ACS usually present with more extensive atherosclerosis, including diffuse coronary calcifications (fig 1), which represents a challenge for the interventional cardiologist (higher risk of periprocedural complications, higher risk of restenosis, etc).

Figure 1

Coronary angiography of a patient with chronic kidney disease and acute non-ST elevation myocardial infarction. (A) Before percutaneous coronary intervention (PCI): critical, unstable (“hazy”) proximal left anterior descending (LAD) stenosis, second stenosis 15 mm distally on LAD, long critical stenosis on diagonal branch, all arteries are diffusely calcified. (B) After PCI: optimal result on proximal LAD after stent implantation, suboptimal (but acceptable) result on diagonal after balloon dilatation (an attempt to deliver stent to this lesion failed due to tortuosity and calcifications).

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Table 1

Cardiorenal syndrome (CRS)*

This review deals with most aspects of the complex ACS–CKD relation, focusing mainly on contrast induced nephropathy (CIN) and the appropriate use of angiographic contrast agents.

Epidemiology and prognosis of renal failure in ACS

CKD has been shown to be quite common among the general population, according to different sources, with a prevalence of about 12% of adults. …

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