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Prognostic impact of reduced kidney function in patients with suspected coronary artery disease undergoing CCTA
Jonathan N Dahl1,2,3, Louise Nissen2, Marie B Nielsen2,4
1Department of Cardiology, Gødstrup Hospital, Herning, Denmark.
Insights
Reduced kidney function, indicated by lower estimated glomerular filtration rate (eGFR), significantly increases the risk of major adverse cardiovascular events (MACE) in patients undergoing coronary computed tomography angiography (CCTA). Chronic kidney disease (CKD) is a critical cardiovascular risk factor, especially with detected coronary artery disease (CAD).
Area of Science:
- Cardiology
- Nephrology
- Radiology
Background:
- Coronary artery disease (CAD) and chronic kidney disease (CKD) share common risk factors.
- The relationship between kidney function and cardiovascular outcomes in patients evaluated with coronary computed tomography angiography (CCTA) is not well-established.
Purpose of the Study:
- To investigate the association between kidney function, measured by estimated glomerular filtration rate (eGFR), and major adverse cardiovascular events (MACE) in symptomatic patients undergoing CCTA.
- To determine if reduced kidney function is an independent risk factor for MACE in this patient population.
Main Methods:
- A cohort study included 70,367 symptomatic patients who underwent CCTA between 2008 and 2021.
- Patients were categorized by eGFR levels (≥90, 60-89, and 30-59 mL/min/1.73 m²).
- Coronary artery disease (CAD) severity was stratified, and MACE (myocardial infarction, ischemic stroke, cardiovascular death) rates were analyzed over a median follow-up of 5.1 years.
Main Results:
- Patients with lower eGFR (60-89 and 30-59) exhibited higher MACE rates compared to those with eGFR ≥90, particularly in the presence of obstructive CAD.
- Hazard ratios for MACE were significantly elevated for eGFR 60-89 (1.09) and eGFR 30-59 (1.42) compared to eGFR ≥90.
- Reduced kidney function was independently associated with increased MACE risk.
Conclusions:
- Decreased kidney function is a significant independent predictor of MACE in patients referred for CCTA due to suspected CAD.
- CKD should be recognized as a potent cardiovascular risk factor, especially in individuals with diagnosed CAD.
- These findings highlight the importance of assessing kidney function in cardiovascular risk stratification.
Aims:
Chronic kidney disease (CKD) and coronary artery disease (CAD) share common risk factors, but the association between kidney function (estimated glomerular filtration rate (eGFR) in mL/min/1.73 m²) and major adverse cardiovascular events (MACE) in patients undergoing coronary computed tomography angiography (CCTA) due to suspected CAD has not been established. This study investigated the association between kidney function and MACE in symptomatic patients undergoing CCTA.
Methods:
A cohort study of consecutive, symptomatic patients undergoing CCTA between 2008 and 2021 (N=70,367). CAD severity was stratified as no CAD, non-obstructive CAD, and obstructive CAD (≥50% diameter stenosis). The primary outcome was MACE (myocardial infarction, ischemic stroke, or cardiovascular death). eGFR was calculated based on plasma creatinine at the time of CCTA.
Results:
In total, 41,156 (59%) had eGFR ≥90, 27,011 (38%) had eGFR 60-89, and 2200 (3%) had eGFR 30-59. Median follow-up were 5.1 years, according to eGFR ≥90, 60-89, and 30-59 groups, MACE rates per 1000 person-years in patients with obstructive CAD were 14.2, 15.4, and 25.8, respectively and in patients with non-obstructive CAD the MACE rates were 6.4, 8.0, and 14.4, respectively. Compared to patients with eGFR ≥90, hazard ratios for MACE were 1.09 (95% confidence intervals (CI) 1.00-1.19) and 1.42 (95%CI 1.18-1.69) for patients with eGFR 60-89 and 30-59, respectively.
Conclusion:
In patients referred for CCTA due to suspected CAD, reduced kidney function was associated with an increased rate of MACE. Therefore, CKD is a strong independent cardiovascular risk factor, particularly in patients with CAD detected on CCTA.
