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Prognostic Value of Renal Function for Cardiac Events in Patients Without Significant Stenosis on Coronary Computed
Hack-Lyoung Kim1, Yong-Jin Kim2, Yeonyee E Yoon3
1Division of Cardiology, Boramae Medical Center, Seoul, Korea. ; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Insights
Renal function, indicated by estimated creatinine clearance (eCCr), predicts cardiovascular events in patients with no significant coronary artery disease (CAD) on CCTA. Impaired renal function warrants careful monitoring and preventive strategies.
Area of Science:
- Cardiology
- Nephrology
- Radiology
Background:
- Coronary computed tomographic angiography (CCTA) is used to assess coronary artery disease (CAD).
- Identifying predictors of major adverse cardiovascular events (MACEs) in patients with non-significant CAD (<50% stenosis) is crucial for risk stratification.
Purpose of the Study:
- To determine clinical parameters predicting future MACEs in patients without significant stenosis on CCTA.
- To evaluate the role of renal function as a predictor of cardiovascular events in this population.
Main Methods:
- Retrospective review of 625 patients with suspected CAD who underwent CCTA showing <50% stenosis.
- Assessment of MACEs (cardiac death, MI, unstable angina, late revascularization) over a mean follow-up of 819 days.
- Multivariable Cox regression analysis to identify independent predictors of MACEs.
Main Results:
- 28 MACEs (4.5%) occurred during follow-up.
- Independent predictors for MACEs were male sex (HR 2.40) and low estimated creatinine clearance (eCCr) < 60 mL/min/1.73 m² (HR 3.07).
- Low eCCr was the sole independent predictor for hard events (cardiac death, MI) (HR 17.6).
Conclusions:
- Renal function (eCCr) is an independent predictor of cardiovascular events in patients without significant CAD on CCTA.
- Patients with impaired renal function, even without significant CAD, require careful monitoring and preventive strategies.
- This highlights the importance of assessing renal function in cardiovascular risk stratification.
Abstract:
This study was conducted to determine clinical parameters predicting future major adverse cardiovascular events (MACEs) in patients without significant stenosis on coronary computed tomographic angiography (CCTA). A total of 625 patients with suspected coronary artery disease (CAD) who underwent CCTA that revealed insignificant (< 50%) CAD was reviewed in three cardiac centers. The MACEs including cardiac death, non-fatal myocardial infarction (MI), unstable angina and late (> 90 days after CCTA) revascularization were assessed. During the mean follow-up period of 819 ± 529 days (median 837 days), there were 28 cases of MACEs (4.5%). In multivariable Cox regression analysis, independent predictors for MACEs were male sex (hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.01-5.69; P = 0.046) and low estimated creatinine clearance (eCCr) (< 60 mL/min/1.73 m(2)) (HR, 3.07; 95% CI, 1.22-7.74; P = 0.017). Low eCCr was the only independent predictor for hard events including cardiac death and MI (HR, 17.6, 95% CI, 1.44-215.7; P = 0.025). In conclusion, renal function is an independent predictor for cardiovascular events among patients without significant CAD by CCTA. Careful monitoring and preventive strategy are warranted in patients with impaired renal function even without significant CAD.
