Predictive Value of Renal Function Biomarkers for Short-Term Outcomes in Patients with Acute Coronary Syndrome: A Study of 110 Cases

Background: Acute Coronary Syndrome (ACS) remains a leading cause of morbidity and mortality worldwide. Renal dysfunction and associated biomarkers have emerged as potential predictors of adverse cardiovascular outcomes. Early identification of high-risk patients using renal biomarkers may improve risk stratification and clinical decision-making.

Objective: To evaluate the predictive value of renal function biomarkers for short-term outcomes in patients with ACS.

Methods: This prospective observational study included 110 patients diagnosed with acute coronary syndrome (ACS) who were admitted to the Department of Cardiology (CC), National Institute of Cardiovascular Diseases & Hospital, Dhaka, Bangladesh, from January to December 2025. Baseline renal function markers, including serum creatinine, estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN) and urine albumin-to-creatinine ratio (ACR) were measured at admission. Patients were followed throughout hospitalization and for up to 30 days after admission to assess the occurrence of major adverse cardiovascular events (MACE), including acute heart failure, significant arrhythmia, reinfarction, cardiogenic shock and all-cause mortality.

Results: Among 110 patients, 42 (38.2%) experienced at least one MACE, while 68 (61.8%) remained free of MACE. The mean age was 58.6±11.4 years and 75 (68.2%) patients were male. STEMI was the predominant ACS presentation, occurring in 57 (51.8%) patients. Patients who developed MACE had higher mean serum creatinine (1.52±0.46 vs. 1.13±0.34 mg/dL), BUN (30.8±10.2 vs. 21.1±7.0 mg/dL) and urinary ACR (105.2±38.4 vs. 62.0±25.1 mg/g), and lower mean eGFR (52.8±14.7 vs. 76.4±16.1 mL/min/1.73 m²); all comparisons were reported as p<0.001. In categorical analysis, eGFR <60 mL/min/1.73 m² was strongly associated with MACE. The supplied multivariable model identified eGFR <60 mL/min/1.73 m² as the strongest independent predictor of MACE (adjusted OR 4.20, 95% CI 2.10–8.60; p<0.001), followed by elevated urinary ACR (adjusted OR 3.40, 95% CI 1.50–7.80; p=0.002).

Conclusion: Renal dysfunction was strongly associated with short-term adverse outcomes among patients with ACS. Reduced eGFR and elevated urinary ACR appeared particularly useful for identifying patients at increased risk of MACE. Routine assessment of renal function at admission may complement established clinical and cardiac risk assessment in ACS. However, the regression estimates should be verified against the original patient-level dataset before final journal submission.

Keywords: Acute Coronary Syndrome, Renal Dysfunction, Estimated Glomerular Filtration Rate, Serum Creatinine, Blood Urea Nitrogen, Albuminuria.