Association of Creatinine Clearance with Left Ventricular Ejection Fraction in Patients with Acute Coronary Syndrome

Open Access

Abstract

Background: Renal dysfunction is an independent predictor of adverse cardiovascular outcomes among patients with acute coronary syndrome. However, the relationship between creatinine clearance and left ventricular systolic function remains incompletely characterized. This study aimed to evaluate the association between creatinine clearance and left ventricular ejection fraction, and to assess clinical outcomes in ACS patients with varying degrees of renal function. Methods & Materials: The prospective observational study was conducted at the Department of Cardiology at Mymensingh Medical College Hospital between October 2022 and September 2023, including 100 consecutive patients with first-episode ACS within 24 hours of symptom onset. The patients were divided into two groups according to their calculated creatinine clearance: Group I (CrCl ≥ 70 ml/min, n = 31) and Group II (CrCl < 70 ml /min, n = 69). The study included a comprehensive clinical assessment, echocardiographic evaluation, and in-hospital monitoring. Data were analyzed using SPSS version 26 with appropriate statistical analysis. Results: The mean age of patients was 51.7±8.5 years, with 88% males. Patients with reduced creatinine clearance were significantly older (53.4±8.4 vs 47.8±7.2 years, p=0.002) and had a higher prevalence of diabetes mellitus (56.5% vs 22.6%, p=0.002). Mean LVEF was significantly lower in the abnormal clearance group (49.4±6.7% vs 56.5±6.0%, p=0.001). In-hospital morbidity was substantially higher in patients with CrCl <70 ml/min (84.0% vs 29.0%, p=0.001), including increased rates of heart failure (28.9% vs 9.6%, p=0.030), ventricular tachycardia (28.9% vs 6.4%, p=0.010), post-MI angina (34.7% vs 6.4%, p=0.002), and cardiogenic shock (21.7% vs 3.2%, p=0.020). Conclusion: Among ACS patients, reduced creatinine clearance is an independent correlate of lower LVEF and significantly higher in-hospital morbidity. Early recognition of renal dysfunction and aggressive risk stratification are strategies that may improve outcomes in this high-risk population.