Abstract 10001: Impact of Renal Dysfunction on Left Main Coronary Artery Disease in Patients with Stable Angina Pectoris
Purpose: Left main coronary artery disease (LMCAD) has previously been shown to lead to the fatal prognosis in patients with coronary artery disease (CAD). Even though a lot of studies identified risk factors for CAD, factors associated with LMCAD remain unclear. Recently cardio-renal interaction has been shown to play a critical role in pathogenesis of CAD. We investigated an impact of renal dysfunction on LMCAD in patients with stable angina pectoris (SAP).
Methods: We performed coronary angiogram to 1601 consecutive patients between 2006 and 2009. A total of 626 consecutive SAP patients with significant stenosis and 20 subjects with absolutely normal angiogram as the control group were enrolled. Patients with SAP were divided into two groups; LMCAD (n=95) and non-LMCAD (n=531). Singnificant stenosis was defined as percent luminal reduction > 50% in left main trunk and > 75% in the other parts. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2, based on the creatinine obtained prior to angiography.
Results: Among three groups, LMCAD patients had significantly lower eGFR (p<0.001 by ANOVA) and higher prevalence of dyslipidemia (p=0.02); however there were no differences in age, sex, presence of diabetes and hypertension, smoking and free fatty acids. In SAP patients, the presence of LMCAD in patients with CKD was significantly higher than that in patients without CKD (18.5% vs 12.2%, p=0.03). Multiple logistic regression analysis revealed that eGFR was independently associated with LMCAD (p<0.001), and the odds ratio of LMCAD for CKD was 1.733 (95% confidence interval [CI]; 1.055 to 2.849, p=0.03) even after adjustment of conventional risk factors. In patients with LMCAD, major adverse cardio-cerebrovascular events in subjects with severe renal dysfunction (eGFR<30) was higher than that in subjects with normal renal function (eGFR>=60) at one year (p<0.02 by Kaplan-Meier analysis). The LMCAD patients with severe renal dysfunction had more clinical events compared to the non-LMCAD patients with normal renal function (hazard ratio, 13.9; 95%CI, 4.06 to 48.28).
Conclusion: Renal dysfunction was independently associated with the presence of LMCAD and clinical outcome with LMCAD in SAP patients.
- © 2011 by American Heart Association, Inc.