Related Experiment Video
Updated: Dec 21, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Comparative Analysis of the Effect of Renal Function on the Spectrum of Coronary Artery Disease
Mohammad Alkhalil1, Claire McCune2, Lisa McClenaghan2
1Department of Cardiology, Royal Victoria Hospital, Belfast, UK; Toronto General Hospital, Canada.
Insights
Renal impairment significantly increases adverse events in ST-segment elevation myocardial infarction patients, but not in stable ischemic heart disease patients. Risk increases exponentially with severe renal dysfunction in myocardial infarction.
Area of Science:
- Cardiology
- Nephrology
- Clinical Medicine
Background:
- Ischemic heart disease (IHD) management is complex, with renal impairment posing a significant challenge.
- Understanding the differential impact of renal impairment across IHD presentations is crucial for risk stratification.
Purpose of the Study:
- To evaluate the varying effects of renal impairment in patients with ischemic heart disease.
- To identify if risk factors modify the association between renal impairment and adverse outcomes.
Main Methods:
- A cohort of 2013 patients undergoing revascularization for ST-segment elevation myocardial infarction (STEMI) or invasive assessment was analyzed.
- Renal impairment was defined as a glomerular filtration rate (GFR) < 60 ml/min/1.73m².
- Primary endpoint: composite of death, myocardial infarction, and unplanned revascularization.
Main Results:
- Renal impairment increased adverse events in STEMI patients (HR 1.77) but not in stable revascularized (HR 1.14) or deferred (HR 1.31) groups.
- Severe renal dysfunction (GFR < 30) showed an exponential risk increase in STEMI patients versus a linear increase in stable patients.
- Age and hypertension differentially impacted outcomes across groups, with inconsistent effects of hypertension.
Conclusions:
- The risk associated with renal impairment in ischemic heart disease is dependent on the clinical presentation.
- Myocardial infarction patients with renal impairment face a substantially higher risk compared to stable ischemic heart disease patients.
Background:
We aim to assess the differential effect of renal impairment across the spectrum of patients with ischaemic heart disease and to study if any established risk factors may modify this risk.
Methods:
A total of 2013 patients who underwent revascularization for ST-segment elevation myocardial infarction or invasive physiology assessment were included. Renal impairment was defined as glomerular filtration rate less than 60 ml/min/1.73m2. Clinical endpoints were prospectively collected, and the primary endpoint was defined as the composite endpoints of death, myocardial infarction, and unplanned revascularization.
Results:
593 (30%) presented with ST-segment elevation myocardial infarction, and 1362 (70%) stable patients had invasive ischaemia assessment which resulted in 37% receiving revascularization and 63% being deferred. Renal impairment was associated with increased adverse events in myocardial infarction [HR 1.77 (95% CI 1.15 to 2.74)], but not in the revascularized stable group [(HR 1.14 (95% CI 0.62 to 2.08)] or the deferred group [HR 1.31 (95% CI 0.84 to 2.03)]. There was an exponential increase in the future risk in ST-segment elevation myocardial infarction patients with severe renal dysfunction (glomerular filtration rate < 30) compared to a linear relationship in stable patients. Age and hypertension were the only two factors that had a differential impact across three groups (P<0.05 for interactions), with inconsistent directional effect of hypertension between medically managed and revascularized groups.
Conclusions:
The magnitude of risk of renal impairment varies according to the clinical presentation of coronary artery disease with more weighted risk in myocardial infarction compared to stable patients.
Related Concept Videos
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:24Serum Studies: Renal Function Tests
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion