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Predictors of Long-Term Prognosis Focused on Kidney Function in Patients with Chronic Coronary Syndrome
Katarzyna Charkiewicz-Szeremeta1,2, Emilia Sawicka-Śmiarowska3, Marlena Dubatówka1
1Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, 15-269 Bialystok, Poland.
Insights
Kidney function, indicated by eGFR and albuminuria, significantly impacts survival in chronic coronary syndrome (CCS) patients. Monitoring hsCRP, hemoglobin, and LVEF aids in identifying high-risk individuals for better long-term outcomes.
Area of Science:
- Cardiology
- Nephrology
- Public Health
Background:
- Growing prevalence of chronic coronary syndromes (CCS) due to increased life expectancy and risk factors.
- Cardiovascular disease remains a leading global cause of mortality and morbidity.
- Focus on kidney function parameters like estimated glomerular filtration rate (eGFR) and albuminuria (uACR) for long-term survival assessment.
Purpose of the Study:
- Identify factors associated with long-term survival in patients with CCS.
- Specifically investigate the role of kidney function (eGFR and albuminuria) in CCS patient prognosis.
- Determine key clinical markers for stratifying mortality risk in CCS.
Main Methods:
- Study included 257 patients (aged ≤ 80) hospitalized for acute coronary syndrome or revascularization.
- An 80-month follow-up period was conducted.
- Kidney function assessed by eGFR and albuminuria (uACR); KDIGO criteria used for kidney dysfunction classification.
Main Results:
- Reduced eGFR and increased albuminuria (ACR) were associated with increased mortality.
- Factors strongly linked to mortality included lower hemoglobin, lower left ventricle ejection fraction (LVEF), and higher hsCRP.
- Higher diastolic blood pressure within the normal range was observed in survivors.
Conclusions:
- Albuminuria measurement, alongside eGFR, improves cardiovascular risk classification for CCS patients.
- hsCRP, hemoglobin concentration, and LVEF are crucial for identifying high-mortality risk CCS patients.
- Optimized risk stratification facilitates appropriate treatment strategies for CCS patients.
Background:
The number of patients with chronic coronary syndromes (CCS) is growing, influenced by factors such as increasing life expectancy and prevalence of risk factors. Thus, cardiovascular (CV) disease remains the leading cause of mortality and morbidity worldwide. The main objective of the study was to identify factors associated with long-term survival in patients with chronic coronary syndrome, with a focus on kidney function described by eGFR and albuminuria (assessed by uACR).
Methods:
The study comprised a total of 257 patients from Bialystok (Poland), aged ≤ 80 years, who 6-18 months earlier were hospitalized for acute coronary syndrome or elective myocardial revascularization. During the 80-month follow-up, 40 (15.6%) patients died, while there was no information about three (1.2%) patients. Patients with preserved eGFR and without albuminuria were characterized by the longest survival, with deterioration of prognosis in groups of progressive kidney dysfunction as defined by KDIGO based on eGFR and uACR. The primary endpoint was death from any cause.
Results:
Those who survived the 80-month follow-up period were younger (p < 0.001), had a lower waist circumference (p = 0.028), higher diastolic blood pressure (p = 0.026), lower NTproBNP (p < 0.001) and hsCRP (p = 0.001) concentrations, reduced eGFR (p = 0.004) and increased ACR (p = 0.023) were strongly associated with mortality. In logistic regression analysis with stepwise elimination of variables, the strongest factors affecting survival were hemoglobin concentration, left ventricle ejection fraction (LVEF) and hsCRP.
Conclusions:
Measurement of albuminuria, in addition to eGFR, allows patients to be correctly classified into CV risk categories and facilitates appropriate treatment of patients with CCS. Higher diastolic blood pressure (but still within normal range) was found in patients who later survived 6 years. Measurements of hsCRP, hemoglobin concentration and LVEF help to identify CCS patients at the highest risk of mortality in long-term follow-up.
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