Abstract 401: Impact of Chronic Kidney Disease on Survival in Patients With Coronary Artery Disease Evaluated by Delayed-Enhancement Magnetic Resonance Imaging
Background: While patients with chronic kidney disease (CKD) are known to have increased mortality, the prognostic value of CKD in patients with myocardial scar documented by delayed enhancement magnetic resonance imaging (DE-MRI) is not known. Using DE-MRI to detect myocardial scar, we sought to test if presence of CKD in patients with coronary artery disease (CAD), was a significant independent predictor of death.
Methods and results: The extent of myocardial scar in 642 patients (385 male, mean age: 61.7 years) with documented CAD referred to a tertiary care institution was assessed using DE-MRI. CKD, defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2 was present in 37% (240) patients, and 370 (57%) patients had significant myocardial scar (defined as DE-MRI >50% thickness in any myocardial segment). Primary end-point was defined as all-cause mortality or cardiac transplantation. During the median follow-up period of 4.4 years, there were 198 deaths and 13 cardiac transplantations. By multivariate Cox analysis, significant independent predictors of death included congestive heart failure, left ventricular ejection fraction <35%, age, DE-MRI scar >50% (hazard ratio [HR] 1.63, 95% CI, 1.20 –2.22) and CKD (HR 1.43, 95% CI, 1.07–1.92). Adjusted Kaplan-Meier survival analysis (see graph) indicated that the survival of patients with DE-MRI scar >50% is worse in the setting of CKD.
Conclusions: CKD is an important independent prognostic factor in patients with CAD, in the presence or absence of myocardial scar. The presence of CKD and the extent of DE-MRI have additive value in risk stratifying patients with known CAD.