To investigate the effect of creatinine clearance (CrCl) on the prognosis of Chinese emergency department (ED) non-valvular atrial fibrillation (AF) patients.

This study prospectively enrolled patients with AF who presented to the ED of 20 hospitals in China from November 2008 to October 2011, and were followed up for 1 year. According to the level of CrCl, the patients were divided into 4 groups: CrCl≥80 ml/min, 50 ml/min≤CrCl<80 ml/min, 30 ml/min≤CrCl<50 ml/min and CrCl<30 ml/min. The primary clinical endpoints were all-cause death, cardiovascular death, thromboembolism, and major bleeding. Univariate and multivariate Cox regression models were used to analyze the effects of different CrCl groups on the above events.

In this study, 863 patients with non-valvular AF were selected as the research subjects. The average age of the patients was (69.4±13.8) years, 57.6% (495/863) were female, and the mean baseline CrCl was (52.9±24.5) ml/min. During 1-year follow-up, 126 (14.6%) patients died.The difference of the all-cause death among the four groups was significant (3.2% vs.6.5% vs.16.2% vs.40.2%, P<0.001). Cardiovascular death and thromboembolic rates also increased with decreasing CrCl levels. In multivariate Cox analysis, all-cause death (HR=5.567; 95%CI 1.618-19.876, P=0.007) and cardiovascular death (HR=11.939; 95%CI 1.439-99.031, P=0.022) risk was highest in CrCl<30 ml/min category, compared with the group CrCl≥80 ml/min. However, for the risk of thromboembolism and major bleeding, after multivariate adjustment, no significant difference was found between the different CrCl groups.

Among Chinese ED non-valvular AF patients, all-cause mortality increased with a decrease in CrCl. CrCl<30 ml/min was an independent risk factor for all-cause mortality and cardiovascular mortality.