الفهرس 
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Abstract
Cardiovascular disease is the main cause of death in patients with kidney failure.
Moreover, the presence of impaired renal function is an important prognostic factor in patients with ischemic heart disease, and is a determinant of outcome during follow-up.
The main aim of this study was to investigate the impact of baseline impaired kidney function on the prognosis of patients with acute coronary syndromes including both STEMI and NSTE/ACS.
According to the glomerular filtration rate the study population was divided into 2 groups using a cutoff 60 mL/min as the lower limit for normal kidney function.
The two groups were subjected to a complete history and thorough clinical examination, laboratory investigation and transthoracic echocardiography.
Traditional cardiovascular risk factors in addition to history of IHD were compared between both groups (diabetes, hypertension, smoking and dyslipidaemia).
Body mass index (BMI) and waist circumference were measured to all study population.
Serum levels of cardiac enzymes and troponin were obtained after 12 hours of maximal pain to both groups in addition to base line hemoglobin level at admission.
Assessments of cardiac systolic and diastolic functions were assessed by echocardiography before discharge, after one month and after 3 month.
Patients were followed up for three months after discharge for major adverse cardiac events.
The results showed that patients in the group of impaired kidney function were significantly older; while patients in the group of normal kidney function were more obese as measured by waist circumference.
Regarding risk factors there was statistically non-significant difference between both groups in diabetes, smoking and hypertension and dyslipiaedemia (except triglycerides level), while, the history of IHD was more significant in the group of impaired kidney function.
At presentation the group of impaired kidney function showed statistically significant higher readings of blood pressure both systolic and diastolic than the group of normal kidney function.
Regarding killip class the group of impaired kidney function presented more with killip class III and IV while the group of normal kidney function presented more with killip I and II (P value 0.046).
There was statistically non-significant difference between both groups in hospital stay (P value 0.087).
Regarding the echocardiographic findings, there was statistically non-significant difference between both groups in systolic function at presentation or during follow up while there was statistically significant deterioration of diastolic dysfunction in the group of impaired kidney function during follow up.
Mortality and re-infarction were higher in the group of impaired kidney function than the group of normal kidney function (9 Vs 3 and 11 Vs 4 respectively) but it was statistically non-significant (P values 0.065 and 0.051 respectively), while the incidence of cardiogenic shock was significantly higher in the group of impaired kidney function (15 Vs 5). (P value 0.015).
Regarding inetrvention, PCI was higher in the group with normal kidney function (7 Vs 3) but it was statistically non-significant (P value 0.164). CABG was equal in both groups (1).
Aspirin, B-blockers, and statins were underutilized in the group of impaired kidney function (P values 0.015, 001 and 0.000 respectively). While there was non-significant difference in use of ACE between both groups ( P value 0.055).