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Published on: January 28, 2020
Relationship between renal function at the time of percutaneous coronary intervention and prognosis in ischemic heart
Daijo Inaguma1, Miho Tatematsu, Hibiki Shinjo
1Department of Nephrology and Rheumatology, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi 489-8642, Japan. dinaguma@r8.dion.ne.jp
Insights
Chronic kidney disease (CKD) significantly worsens outcomes for patients with ischemic heart disease undergoing percutaneous coronary intervention (PCI). Renal dysfunction increases mortality and decreases survival rates, highlighting the importance of kidney health in cardiovascular disease management.
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Increasing prevalence of hypertension and diabetes mellitus contributes to a rise in cardiovascular disease (CVD) complications.
- Chronic kidney disease (CKD) is increasingly recognized as a significant independent risk factor for CVD.
- This study investigates the association between ischemic heart disease and CKD.
Purpose of the Study:
- To examine the relationship between chronic kidney disease (CKD) and outcomes in patients with ischemic heart disease undergoing percutaneous coronary intervention (PCI).
- To identify risk factors associated with mortality and survival in this patient population.
- To assess the impact of renal function on prognosis following PCI.
Main Methods:
- A retrospective review of 790 patients who underwent PCI for angina or myocardial infarction between 2000 and 2005.
- Serum markers and renal function (estimated glomerular filtration rate - eGFR) were assessed at the time of PCI.
- Prognostic outcomes including in-hospital mortality, 1-year survival, and overall mortality were analyzed, with renal function monitored during follow-up.
Main Results:
- Over half (51.5%) of patients had Stage 2 CKD at the time of PCI, with a mean eGFR of 66.2 ml/min/1.73 m(2).
- Progressive CKD stages correlated with increased all-cause, CVD, and in-hospital mortality, and decreased 1-year survival rates.
- Independent risk factors for all-cause death included hypertension, hyperlipidemia, diabetes, multiple vessel lesions, hypoalbuminemia, CRP, and eGFR; CVD death additionally included anemia and total cholesterol. Renal function significantly deteriorated during follow-up.
Conclusions:
- Renal dysfunction is common in patients with ischemic heart disease requiring PCI and significantly impacts their prognosis.
- CKD progression is associated with adverse cardiovascular outcomes and increased mortality.
- Close monitoring and management of renal function are crucial for improving outcomes in patients with ischemic heart disease.
Background:
As hypertension and diabetes mellitus increase, the number of patients developing complications of cardiovascular disease (CVD) associated with conventional risk factors is increasing. In addition to these risk factors for CVD, chronic kidney disease (CKD) has also been reported to play an important role. We investigated the association of representative ischemic heart disease and CKD.
Methods:
Between July 1, 2000, and June 30, 2005, a total of 790 patients who underwent percutaneous coronary intervention (PCI) for angina pectoris or myocardial infarction in our division of cardiovascular disease were reviewed. Serum markers at the implementation of PCI were compared in patients classified according to renal function. For prognosis, in-hospital mortality, 1-year survival rate, overall mortality, and CVD death were investigated. Changes in renal function were also monitored during the follow-up period. The glomerular filtration rate (GFR) was calculated by the Modification of Diet in Renal Disease Study Group (MDRD) formula.
Results:
The mean estimated GFR (eGFR) at PCI implementation was 66.2 +/- 21.0 ml/min/1.73 m(2). Stage 2 CKD was shown in 51.5% of all the patients. During the overall follow-up period, 126 patients died. With the progression of CKD stage, all-cause, CVD, and in-hospital mortality increased, and the 1-year survival rate decreased. It was proved that a medical history of hypertension, hyperlipidemia, and diabetes, multiple vessel lesions, hypoalbuminemia, C-reactive protein (CRP), and estimated GFR were independent risk factors for all-cause death. In CVD death, in addition to the above risk factors, anemia and total cholesterol were also an independent risk factor. Renal function deteriorated significantly during the follow-up period.
Conclusions:
Patients with ischemic heart disease requiring PCI often develop renal dysfunction, which may considerably affect prognosis.
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