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Published on: June 28, 2019
Renal insufficiency and mortality in coronary artery disease with reduced ejection fraction
Yong Peng1, Tian-Li Xia1, Wei Liu1
1Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
Insights
Reduced kidney function significantly increases mortality risk in coronary artery disease patients with reduced ejection fraction (EF). Optimal medical therapy, including beta-blockers, ACEIs/ARBs, and statins, improves survival, even with impaired renal or cardiac function.
Area of Science:
- Cardiology
- Nephrology
- Public Health
Background:
- Decreased estimated glomerular filtration rate (eGFR) is linked to adverse cardiovascular outcomes.
- The impact of eGFR on mortality in coronary artery disease (CAD) patients with varying left ventricular ejection fraction (EF) requires further clarification.
Purpose of the Study:
- To investigate the relationship between eGFR and mortality in CAD patients stratified by EF.
- To assess the influence of renal function on all-cause and cardiac mortality in CAD patients with preserved versus reduced EF.
Main Methods:
- Retrospective cohort study of 2161 CAD patients (July 2008 - January 2012).
- Patients categorized into three eGFR groups (≥90, 60-90, <60 mL/min/1.73m²).
- Patients classified by EF (≥50% preserved EF, <50% reduced EF); endpoints were all-cause and cardiac mortality.
Main Results:
- In patients with reduced EF, renal insufficiency significantly increased all-cause (29.3% vs. 5.4%) and cardiac mortality (18.2% vs. 4.5%) in a graded manner.
- Moderate to severe renal insufficiency heightened all-cause mortality 6.10-fold and cardiac mortality 4.10-fold in CAD patients with reduced EF.
- Medication use (beta-blockers, ACEIs/ARBs, statins) was lower in renal insufficiency patients, particularly those with reduced EF, despite being associated with decreased mortality risk.
Conclusions:
- Renal function significantly impacts prognosis in CAD patients, especially those with reduced EF.
- Renal insufficiency in CAD patients with reduced EF is associated with substantially higher risks of all-cause and cardiovascular mortality.
- Increased use of guideline-directed medical therapies, including beta-blockers, ACEIs/ARBs, and statins, is associated with reduced mortality, even in patients with impaired renal or cardiac function.
Background:
Despite strong evidence linking decreased estimated glomerular filtration rate (eGFR) to worse cardiovascular outcome, the impact of eGFR on mortality in coronary artery disease (CAD) patients with different left ventricular ejection fraction (EF) is not well defined.
Methods:
A retrospective cohort study. From Jul. 2008 to Jan. 2012, consecutive patients with CAD of West China Hospital were enrolled and were grouped into 3 eGFR categories: ≥90, 60-90, and <60mL/min/1.73m(2). Patients with EF≥50% or <50% were defined as preserved EF or reduced EF, respectively. The endpoints were all-cause mortality and cardiac mortality.
Results:
There are 2161 patients according to the inclusion criteria and follow-up requirement. The mean follow-up time was 30.97±11.70months. Cumulative survival curves showed that in patients with reduced EF, renal insufficiency significantly increases all-cause mortality and cardiovascular mortality in a graded fashion (mortality rate, moderate or severe vs. normal: 29.3% vs. 5.4%, p<0.001; cardiac mortality rate, moderate or severe vs. normal: 18.2% vs. 4.5%, p=0.001, respectively). Cox regression analysis showed that in CAD patients with reduced EF, moderate to severe renal insufficiency increased all-cause mortality by 6.10-fold (HR 6.10, 95% CI 2.50 to 14.87) and cardiac mortality by 4.10-fold (HR 4.10, 95% CI 1.51 to 11.13). Use of beta-blockers, angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), and statins was associated with decreased risk of mortality, but the use was lower in renal insufficiency patients, especially in combination of reduced EF.
Conclusion:
This study has found that the effect of renal function on prognosis in patients with CAD is closely related to cardiac function. In patients with reduced EF, renal insufficiency accompanies the higher risks of all-cause mortality and cardiovascular mortality. A higher number of treatments from beta-blocker, ACEIs or ARBs, and statin therapy were associated with decreased risk of mortality, even in the combination of renal insufficiency or declining cardiac function.
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