Abstract 13235: Mild Renal Insufficiency Predicts Mortality and Adverse Events in Women With Cardiac Ischemia, Independent of the Underlying Obstructive Coronary Artery Disease
Introduction: Chronic kidney disease (CKD) is associated with accelerated atherosclerosis, adverse cardiovascular events and decreased survival. Since CKD is associated with microvascular dysfunction, we hypothesized that mild renal dysfunction will be an independent predictor of adverse cardiac events and mortality in women with symptoms and signs of cardiac ischemia.
Methods: We studied 838 women from the WISE cohort who underwent coronary angiography for clinically suspected ischemia and were followed for adverse outcomes. We categorized them according to estimated glomerular filtration rate (eGFR) [eGFR>90-normal, eGFR 60-90 mild and eGFR<60 severe renal dysfunction]. Time to death from all causes, cardiovascular causes, as well as major adverse events were stratified by renal function. Multivariate regression analysis was done adjusting for baseline covariates using a Cox regression model.
Results: The majority (61%) of the women, despite risk factors, chest pain and signs of ischemia did not have obstructive CAD (> 50% stenosis). The median follow up was 9.3 years (IQR 8.3, 10.3 years). Compared to those with normal renal function, mild renal insufficiency was associated with a two-fold increased risk of all-cause mortality [HR 2.01(95%CI 1.38-2.92, p<0.0005)] and cardiovascular mortality [HR 1.72(95%CI 1.06-2.79), p<0.05] while severe renal dysfunction was associated with a 4-5 fold risk of all-cause mortality [HR 4.70(95%CI 3.16-7.00), p<0.0001] and cardiovascular mortality [HR 3.57(95%CI 1.95-5.37), p<0.001]. Even after adjusting for severity of underlying CAD, renal function remained a strong and independent predictor of all-cause and cardiac mortality (p<0.001). Each 10-unit decrease in eGFR was associated with increased risk ranging from 5% for major cardiovascular events, 12% for all-cause mortality, to 15% for cardiovascular mortality.
Conclusions: Mild renal insufficiency is a strong and independent predictor of all-cause and cardiac morality in women with symptoms and signs suggesting ischemia, regardless of the severity of underlying obstructive CAD. This has important prognostic implications and underscores the need for better understanding of the mechanistic basis of the vasculopathy among such women.
- © 2013 by American Heart Association, Inc.