Changes in Serum Creatinine and Potassium after Initiation of Perindopril Post Acute Coronary Syndrome (ACS)

Background: While Angiotensin Converting Enzyme inhibitors (ACEi) are important in preventing cardiac remodeling post acute coronary syndrome (ACS), it also acutely increases serum creatinine and reduces glomerular filtration rate (GFR). Current guidelines advocates monitoring serum creatinine and potassium 2 weeks post initiation and accepts up to 30% increase in creatinine from baseline. We aim to assess the increase in serum creatinine and potassium after the initiation of perindopril in post ACS patients and to identify patient characteristics associated with different levels of creatinine increase. Methodology: This is a retrospective observational, cross-sectional study analyzing data collected from the patient electronic records. 143 patients with complete data were available for analysis. Results: Mean baseline creatinine was 91.5 ± 18.9mcmol/l increasing significantly to 95.7 ± 21.6mcmol/l (p<0.001). Logistic regression analysis predicted older age, increasing BMI and lower baseline creatinine to have a significantly higher chance of developing creatinine increases ≥10%. Adjusted odds ratio was 1.042 (95% confidence interval (CI) 1.00- 1.08), 1.103 (95% CI 1.02 - 1.20) and 0.959 (95% CI 0.94 - 0.98) respectively. Conclusion: Acute increases in serum creatinine and potassium can be seen 2 weeks into the treatment. However, ACEi induced renal impairment is rare. Further studies need to be done to risk stratify patients to recommend a more robust and cost effective monitoring protocol in our resource limited setting.