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Prognostic Impact of Mildly Impaired Renal Function in Patients Undergoing Multivessel Coronary Revascularization

Tae Oh Kim1, Do-Yoon Kang1, Jung-Min Ahn1

  • 1Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Journal of the American College of Cardiology
|April 1, 2022
PubMed

Insights

Mildly decreased kidney function in patients undergoing coronary revascularization does not increase adverse outcomes. Outcomes after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) were similar in patients with mild renal dysfunction.

Area of Science:

  • Cardiology
  • Nephrology
  • Clinical Outcomes Research

Background:

  • The long-term prognosis for patients with mildly reduced kidney function undergoing coronary revascularization remains unclear.
  • Assessing the impact of renal function on outcomes after coronary revascularization is crucial for risk stratification.

Purpose of the Study:

  • To evaluate the long-term prognostic significance of mild renal dysfunction in patients undergoing coronary revascularization.
  • To compare outcomes between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with varying degrees of renal function.

Main Methods:

  • Analysis of 10,354 patients from the Asan Medical Center-Multivessel Revascularization registry.
  • Patients were categorized into three groups based on estimated glomerular filtration rate: normal (Stage I), mild (Stage II), and moderate (Stage III) renal dysfunction.
  • Propensity score matching was employed to ensure comparable baseline characteristics between groups. The primary outcome was a composite of death, myocardial infarction, or stroke.

Main Results:

  • No significant difference in the primary composite outcome risk was observed between patients with normal renal function (Stage I) and mild renal dysfunction (Stage II) (HR: 1.12; 95% CI: 0.97-1.30).
  • Patients with moderate renal dysfunction (Stage III) faced a significantly higher risk of the primary outcome compared to those with normal function (HR: 1.50; 95% CI: 1.22-1.84).
  • The comparative effectiveness of PCI versus CABG for the primary outcome was consistent across all renal function stages in the matched cohorts.

Conclusions:

  • Mildly decreased renal function in patients with multivessel disease undergoing coronary revascularization (PCI or CABG) is not associated with an increased risk of adverse composite outcomes or mortality.
  • PCI and CABG demonstrate similar comparative outcomes in patients with borderline renal function.
  • These findings support current revascularization strategies regardless of mild renal impairment.
Abstract

Keywords:
coronary artery bypass graftingcoronary artery diseaseglomerular filtration ratepercutaneous coronary interventionrenal function

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