Factors Affecting Time to Major Adverse Cardiac Events (MACE) in Acute Coronary Syndrome (ACS) Patients With Concomitant Chronic Kidney Disease (CKD

Background: Major adverse cardiac events (MACE) is a composite end points commonly used in cardiovascular researches to describe complications and mortalities following particular cases, one such case being acute coronary syndrome (ACS). Combined with chronic kidney disease (CKD), this patient group suffers from higher risk of atherosclerosis and eventual complications. Increased level of kidney regulated protein such as B2MG and FGF23 can act as biomarkers in CKD, which in turn can be a risk marker for ACS. Objective: To find factors affecting duration to MACE in aforementioned patients. Method: ACS patient undergoing angiography in RSUPN-CM was checked for kidney function and those with GFR <89 ml/min/1,73m2 are included in the data. Bivariate analysis and logistic regression were then performed. Result: From 117 patients in the study, 81 (69%) are males, 70 (40%) are less than 60 years old, and 56 (48%) are of Javanese descent. From bivariate analysis we find significant association between hemoglobin (p=0.041), FGF23 (p=0.040), and B2MG (p=0.032) level on admission and time to MACE. Yet we find no significant association between comorbidities specifically diabetes mellitus (p=0.419), dyslipidemia (p=0.254), hypertension (p=0.216), and stage of CKD (p=0.069) and time to MACE. Further multivariate analysis with logistic regression shows significant association between level of FGF23 (OR 0.454; CI 95% 0.212-0.912; p=0.026) and time to MACE in ACS patients with CKD. Conclusion: There is significant association between time to MACE and the hemoglobin, B2MG, and FGF23 level on admission, with the latter almost cutting the time in half, in ACS patient with CKD. Markers of kidney disease may be a better predictor of MACE in ACS patient with concomitant CKD than the disease stage itself.