The Prognostic Impact of Kidney Dysfunction in Unselected Patients Undergoing Coronary Angiography: In What Subgroups...

Area of Science:

• Cardiology
• Nephrology
• Public Health

Background:

• Demographic shifts and improved cardiovascular disease treatments have changed patient profiles undergoing coronary angiography (CA).
• Limited data exist on the impact of kidney dysfunction on outcomes stratified by CA indication.

Purpose of the Study:

• To assess the prevalence and extent of coronary artery disease (CAD) in patients with varying kidney function levels.
• To examine the long-term effects of impaired kidney function on rehospitalization risks for heart failure (HF), acute myocardial infarction (AMI), and need for revascularization post-CA.

Main Methods:

• Analysis of consecutive patients undergoing invasive CA between 2016 and 2022.
• Stratification of patients based on estimated glomerular filtration rate (eGFR) levels.
• Assessment of CAD prevalence, extent, and 36-month follow-up outcomes including HF rehospitalization, AMI, and revascularization.

Main Results:

• A total of 7624 patients were included, with 7.3% having eGFR < 30 mL/min/1.73 m², 29.0% with eGFR 30-60 mL/min/1.73 m², and 63.7% with eGFR ≥ 60 mL/min/1.73 m².
• Patients with lower eGFR (<60 mL/min/1.73 m²) showed a higher prevalence of CAD and three-vessel CAD (p=0.001).
• Impaired kidney function (eGFR <60 mL/min/1.73 m²) was associated with significantly higher risks of HF-associated rehospitalization and AMI at 36 months (p=0.001), persisting after multivariable adjustment.

Conclusions:

• Impaired kidney function significantly increases the risk of 36-month HF-related rehospitalization, even after multivariable adjustments.
• The risk of HF rehospitalization is particularly high in patients with eGFR < 30 mL/min/1.73 m² who also have decompensated HF and LVEF < 35%.
• In patients with eGFR 30-60 mL/min/1.73 m², angina pectoris and multivessel disease further elevate the risk of HF-related rehospitalization.