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Incremental prognostic value of kidney function decline over coronary artery disease for cardiovascular event
Marcio S Bittencourt1, Edward A Hulten2, Brian Ghoshhajra3
11] Department of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA [2] Heart Institute (InCor), University of São Paulo, São Paulo, Brazil.
Insights
Mild chronic kidney disease (CKD) independently predicts cardiovascular events and death, even in patients without coronary artery disease (CAD). Combining CKD assessment with coronary computed tomography angiography (CCTA) improves risk prediction for cardiovascular events.
Area of Science:
- Cardiology
- Nephrology
- Medical Imaging
Background:
- Cardiovascular disease (CVD) is a leading cause of mortality.
- Chronic kidney disease (CKD) is an independent risk factor for CVD.
- The combined impact of CKD and coronary artery disease (CAD) on cardiovascular prognosis requires further elucidation.
Purpose of the Study:
- To investigate the independent and combined roles of CKD and CAD in predicting adverse cardiovascular outcomes.
- To assess the predictive value of coronary computed tomography angiography (CCTA) in conjunction with kidney function for cardiovascular events.
Main Methods:
- A registry-based study including 1541 patients referred for CCTA.
- Patients were categorized based on the presence and severity of CAD (normal, nonobstructive, obstructive).
- Estimated glomerular filtration rate (eGFR) was used to assess kidney function (eGFR < 60 ml/min/1.73 m²).
Main Results:
- Both the presence/severity of CAD and reduced eGFR were significantly associated with increased rates of cardiovascular death, myocardial infarction, and all-cause death.
- Reduced eGFR independently predicted adverse outcomes, even in patients without obstructive CAD.
- Integrating eGFR into models with clinical variables and CCTA findings significantly improved the prediction of cardiovascular events.
Conclusions:
- Renal dysfunction is a significant predictor of cardiovascular events in patients undergoing CCTA for CAD evaluation.
- The combination of eGFR and CAD assessment via CCTA enhances the prediction of future cardiovascular events and mortality.
- CKD contributes to cardiovascular risk, particularly through non-coronary cardiovascular events.
Abstract:
It is unknown whether mild chronic kidney disease (CKD) is associated with adverse cardiovascular (CV) prognosis after accounting for coronary artery disease (CAD). Here we evaluated the interplay between CKD and CAD in predicting CV death or myocardial infarction (MI) and all-cause death. We included 1541 consecutive patients in the Partners registry (mean age 55 years, 43% female) over 18 years old with no known prior CAD who underwent coronary computed tomography angiography (CCTA). The results of CCTA were categorized as normal, nonobstructive (under half), or obstructive (half and over). Overall, 653 of the patients had no CAD, 583 had nonobstructive CAD, and 305 had obstructive CAD, while 1299 had eGFR over 60 ml/min per 1.73 m(2) and 242 had an eGFR under this value. The presence and severity of CAD was significantly associated with an increased rate of CV death or MI and all-cause death, even after adjustment for age, gender, symptoms, and risk factors. Similarly, reduced eGFR was significantly associated with CV death or MI and all-cause death after similar adjustment. The addition of reduced GFR to a model which included both clinical variables and CCTA findings resulted in significant improvement in the prediction of CV death or MI and all-cause death. Thus, among individuals referred for CCTA to evaluate CAD, renal dysfunction is associated with an increased rate of CV events, mainly driven by an increase in the rate of noncoronary CV events. In this group of patients, both eGFR and the presence and severity of CAD together improve the prediction of future CV events and death.
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