Copyright ©2012 Baishideng. All rights reserved.
World J Nephrol. Oct 6, 2012; 1(5): 134-145
Published online Oct 6, 2012. doi: 10.5527/wjn.v1.i5.134
Chronic kidney disease in acute coronary syndromes
Giancarlo Marenzi, Angelo Cabiati, Emilio Assanelli
Giancarlo Marenzi, Angelo Cabiati, Emilio Assanelli, Centro Cardiologico Monzino, IRCCS Department of Cardiovascular Sciences, University of Milan, 20138 Milan, Italy
Author contributions: All authors contributed to this editorial.
Correspondence to: Giancarlo Marenzi, MD, Centro Cardiologico Monzino, IRCCS Department of Cardiovascular Sciences, University of Milan, Via Parea 4, 20138 Milan, Italy.
Telephone: +39-2-580021 Fax: +39-2-580021
Received: August 20, 2011
Revised: August 20, 2012
Accepted: September 25, 2012
Published online: October 6, 2012

Chronic kidney disease (CKD) is associated with a high burden of coronary artery disease. In patients with acute coronary syndromes (ACS), CKD is highly prevalent and associated with poor short- and long-term outcomes. Management of patients with CKD presenting with ACS is more complex than in the general population because of the lack of well-designed randomized trials assessing therapeutic strategies in such patients. The almost uniform exclusion of patients with CKD from randomized studies evaluating new targeted therapies for ACS, coupled with concerns about further deterioration of renal function and therapy-related toxic effects, may explain the less frequent use of proven medical therapies in this subgroup of high-risk patients. However, these patients potentially have much to gain from conventional revascularization strategies used in the general population. The objective of this review is to summarize the current evidence regarding the epidemiology and the clinical and prognostic relevance of CKD in ACS patients, in particular with respect to unresolved issues and uncertainties regarding recommended medical therapies and coronary revascularization strategies.

Keywords: Chronic kidney disease, Acute coronary syndromes, Non-ST-elevation myocardial infarction, ST-elevation myocardial infarction, Percutaneous coronary intervention, Renal insufficiency