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Renal Dysfunction, Coronary Artery Lesion Complexity, and Adverse Cardiovascular Outcomes in Patients With Acute

Qiang Chen1,2, Yike Li1,2, Siqi Yang3

  • 1Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 100029 Beijing, China.

Reviews in Cardiovascular Medicine
|August 8, 2025
PubMed

Insights

Coronary lesion complexity partially explains the link between renal dysfunction and adverse cardiovascular events in acute coronary syndrome patients. This highlights the need to combine kidney function and coronary anatomy assessments for better risk prediction.

Area of Science:

  • Cardiology
  • Nephrology
  • Vascular Biology

Background:

  • Renal dysfunction is associated with complex coronary artery lesions and poor prognosis in acute coronary syndrome (ACS).
  • The precise mechanisms linking renal dysfunction, coronary lesion complexity, and cardiovascular outcomes in ACS remain incompletely understood.

Purpose of the Study:

  • To investigate how coronary lesion complexity mediates the relationship between renal dysfunction and adverse cardiovascular outcomes in patients with ACS.

Main Methods:

  • 1400 ACS patients undergoing percutaneous coronary intervention (PCI) were analyzed.
  • Renal function was assessed by estimated glomerular filtration rate (eGFR) using the 2021 CKD-EPI equation.
  • Coronary lesion complexity was quantified by the baseline SYNTAX score (bSS).
  • Associations between eGFR, bSS, and major adverse cardiovascular events (MACEs) were evaluated using survival, restricted cubic spline, and mediation analyses.

Main Results:

  • A total of 229 MACEs (16.4%) occurred during a median follow-up of 31.03 months.
  • Both eGFR and bSS independently predicted MACEs in ACS patients.
  • Mediation analysis revealed that bSS accounted for 11.95% to 16.49% of the association between eGFR and MACEs across different models.

Conclusions:

  • Coronary lesion complexity partially mediates the link between renal dysfunction and MACEs in ACS patients.
  • Integrating renal function and coronary anatomy assessments is crucial for individualized risk stratification in ACS.
Abstract

Keywords:
SYNTAX scoreacute coronary syndromecystatin Cestimating glomerular filtration ratemediation

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