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Low GFR amplifies the association between coronary three-vessel disease and all-cause mortality
Pamela Piscitelli1, Maria M D'Errico1, Antonio Mirijello1
1Unit of Internal Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy.
Insights
Three vessel disease (3VD) significantly increases mortality risk. Low estimated glomerular filtration rate (eGFR) further amplifies this risk, highlighting kidney disease as a critical multiplier for cardiovascular mortality.
Area of Science:
- Cardiology
- Nephrology
- Public Health
Background:
- Three vessel disease (3VD) is linked to poorer prognosis and increased mortality.
- Chronic kidney disease (CKD) independently elevates the risk of premature death, primarily from coronary artery disease (CAD).
Purpose of the Study:
- To assess the prognostic impact of 3VD on all-cause mortality in high-risk patients undergoing coronary angiography (CA).
- To investigate if reduced estimated glomerular filtration rate (eGFR) modifies the mortality risk associated with 3VD.
Main Methods:
- 1017 patients undergoing CA (2016-2018) were analyzed.
- Patients were categorized by CAD severity (3VD vs. no 3VD) and eGFR levels.
- Mortality risk was analyzed across four groups based on 3VD and low eGFR status.
Main Results:
- The study included 1017 patients (759 male, mean age 68.4 ± 11 years).
- Over a median follow-up of 44 months, 114 deaths occurred.
- 3VD nearly doubled the risk of death (adjusted HR=1.61). Patients with both low eGFR and 3VD faced the highest mortality risk (adjusted HR=3.88).
Conclusions:
- Low eGFR significantly exacerbates the all-cause mortality risk in patients with 3VD.
- Kidney disease acts as a potent risk multiplier for both cardiovascular and overall mortality.
- Preventing CKD onset and progression is crucial for reducing cardiovascular mortality.
Background And Aim:
Three vessels disease (3VD) has been associated with worse prognosis and higher mortality. Chronic kidney disease (CKD) is an independent risk factor for premature death, mostly due to coronary artery disease (CAD). We aim to examine the prognostic impact of 3VD on all-cause mortality in a cohort of high cardiovascular risk subjects undergoing coronary angiography (CA) and to explore whether low eGFR (<60 ml/min/1.73 m2) modulates the risk of all-cause mortality associated to 3VD.
Methods And Results:
One-thousand-seventeen subjects (759 M, mean age 68.4 ± 11 years) consecutive subjects undergoing CA from 2016 to 2018 were evaluated. Subjects were classified according to the severity of CAD as follows: group "three vessels disease" (3VD), and "no three vessels disease" (No 3VD). Serum creatinine was measured to estimate glomerular filtration rate (eGFR). The whole population was divided into 4 groups (A, B, C, D), according to the presence/absence of low eGFR and/or 3VD. One-hundred-fourteen deaths occurred (median follow-up:44 months). The risk of death in subjects with 3VD was almost 2-time higher than subject without 3VD (adjusted HR = 1.61; 95% CI 1.094-2.373, p = 0.0157). Among 4 subgroups, subjects with low eGFR and 3VD (Group D) had the highest risk of death (adjusted HR = 3.881; 95% CI 2.256-6.676, p < 0.0001).
Conclusions:
Low eGFR significantly amplifies the risk of all-cause mortality associated to 3VD. Our results strengthen the role of kidney disease as a risk multiplier for cardiovascular and all-cause mortality and highlight the need to prevent its onset and progression.
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