Abstract 17863: Renal Function and Coronary Artery Disease Progression in Patients with Acute Coronary Syndrome
Background: Renal dysfunction is a powerful predictor of adverse outcomes in acute coronary syndrome (ACS); however, its underlying mechanism has not been fully elucidated. Although renal dysfunction has been shown to be associated with the severity of coronary artery disease (CAD), the relation between renal function and CAD progression remains unclear.
Methods: We studied 209 patients with ACS who underwent percutaneous coronary intervention (PCI) for culprit lesion during initial hospitalization. All patients underwent serial coronary angiograms (CAGs) immediately before PCI, and at 8 + 3 months and 60 + 10 months after presentation. Coronary disease progression (CP) was defined as an increase > 15 % in stenosis severity of lesion in nonculprit artery between 2 serial CAGs. Estimated glomerular filtration rate (eGFR), cardiac-specific troponin T and lipid profiles were measured on initial admission. Patients were divided into tertiles according to eGFR at initial admission: the lower [T1; eGFR 54 + 9 mL/min/1.73m2, n=70], the middle [T2; eGFR 71 + 6 mL/min/1.73m2, n=69], and the upper tertile [T3; eGFR 102 + 20 mL/min/1.73m2, n=70].
Results: There were no differences in gender, coronary risk factors, lipid profiles, positive-troponin T, follow-up periods and medications in the 3 groups. In T1,T2, and T3, ages were 68 + 7, 63 + 10, and 60 + 11 years (p<0.001). The rate of multivessel disease were 71, 55, and 51 % (p=0.047). The rate of CP between first and second CAGs was highest in T1 (41%), followed by T2 (24%), and lowest in T3 (21%) (p=0.046). The rate of CP between second and final CAGs was highest in T1 (49%, 31%, and 30% in T1, T2, and T3, respectively; p=0.033). Multivariate analysis revealed that T1 (OR 2.82, 95% CI 1.12 to 6.64, p=0.018) and age > 65 years (OR 2.68, 95% CI 1.08 to 6.64, p=0.033) were independently associated with the presence of both of CP between each of 2 serial CAGs.
Conclusions: In patients with ACS, renal function is associated with not only the severity of CAD but also continuous CAD progression. These findings may partly explain adverse outcomes in patients with renal dysfunction.
- © 2011 by American Heart Association, Inc.