[Renal failure in patients after acute coronary syndrome--does it change the standards? From theory to practice].

Standards for secondary prevention in patients after acute coronary syndromes have been recently published by the European Society of Cardiology. They do not differ between patients without or with renal failure, but it may be suggested that the later group deserves special attention and more aggressive treatment. Both after myocardial infarction and unstable angina, practically all patients are supposed to receive antiplatelet therapy, statins, beta-blockers and angiotensin-converting enzyme (ACE) inhibitors. They also are submitted to intensive coronary risk factor modifications. In recently undertaken Polish registry study of secondary prevention in acute myocardial infarction/unstable angina survivors and post-revascularization patients (STOK--Standard Terapii i Opieki Kardiologicznej trial) over 31,000 records of individual patients discharged from internal disease or cardiologic wards in Poland in 2002 were gathered. When records of 2,780 patients with concomitant elevated serum creatinine were compared with data of 28,585 patients with normal renal function, some interesting conclusions were drawn. Firstly, the group of patients with suspected renal dysfunction was characterized with more often recognized: diabetes, heart failure and peripheral vessel disease. Secondly paradoxically--they were less often prescribed with antiplatelet drugs, statins, beta-blockers and ACE inhibitors. Thus theory do not translate into practice.