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The Prognostic Impact of Kidney Dysfunction in Unselected Patients Undergoing Coronary Angiography: In What Subgroups
Philipp Steinke1, Ibrahim Akin1, Lasse Kuhn1
1Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
Insights
Patients with impaired kidney function undergoing coronary angiography face a higher risk of heart failure rehospitalization. This risk is significantly elevated in those with lower eGFR levels, even after adjustments.
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.
Abstract:
Background/Objectives: In recent decades, shifting demographics and advancements in treating cardiovascular disease have altered the types of patients receiving coronary angiography (CA). However, data investigating the impact of kidney dysfunction stratified by the indication for CA are limited. Methods: Consecutive patients who underwent invasive CA at one institution between 2016 and 2022 were included in this study. Firstly, the prevalence and extent of coronary artery disease (CAD) in patients with different levels of kidney function was assessed. Secondly, the study examined how impaired kidney function affected long-term outcomes-specifically the risk of rehospitalization for heart failure (HF), acute myocardial infarction (AMI), or the need for coronary revascularization-at 36 months of follow-up. Results: A total of 7624 patients undergoing CA were included with a median estimated glomerular filtration rate (eGFR) of 68.9 mL/min/1.73 m2 (IQR: 50.8-84.3). In total, 63.7% of patients had an eGFR ≥ 60 mL/min/1.73 m2, 29.0% an eGFR of 30-<60 mL/min/1.73 m2, and 7.3% an eGFR of <30 mL/min/1.73 m2. Compared to patients with an eGFR ≥ 60 mL/min/1.73 m2, those with an eGFR 30-<60 mL/min/1.73 m2 and eGFR < 30 mL/min/1.73 m2 had a higher prevalence of CAD (66.8% vs. 72.9% and 80.1%, respectively; p = 0.001) and three-vessel CAD (25.6% vs. 34.5% and 39.5%, respectively; p = 0.001). At 36 months of follow-up, patients with an eGFR 30-<60 mL/min/1.73 m2 and eGFR < 30 mL/min/1.73 m2 suffered from significantly higher risk of HF-associated rehospitalization (HR = 1.937, 95% CI: 1.739-2.157, p = 0.001 and HR = 3.223, 95% CI: 2.743-3.787, p = 0.001, respectively) and AMI compared to patients with an eGFR ≥ 60 mL/min/1.73 m2 (reference group). The significantly higher risk of HF-related rehospitalization remained after multivariable adjustment. Conclusions: Both groups with impaired kidney function demonstrated a markedly higher risk of rehospitalization for HF at 36 months-even after multivariate adjustments. Increased risk of HF-related rehospitalization in patients with an eGFR < 30 mL/min/1.73 m2 was especially evident if they also presented with decompensated HF and LVEF < 35%. In patients with an eGFR 30-<60 mL/min/1.73 m2, presenting with angina pectoris and multivessel disease increased the risk of HF-related rehospitalization.
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