Abstract 19764: Impact of Chronic Kidney Dysfunction Among Patients With Stable Coronary Artery Disease: Ten-Year Follow-Up of Mass II Trial
Introduction: Chronic kidney disease (CKD) has poor prognosis among patients with stable coronary artery disease (CAD), but there is a lack of evidence regarding long term follow-up. Our objective was to evaluate the CKD in patients with multivesselCAD preserved ventricular function, and the interaction betweenreceived treatment and mortality in a 10-year follow-up.
Hypothesis: CKD level would interact with treatment options regarding mortality.
Methods: The glomerular filtration rate was determined at baseline on 611 patients who were randomized intothree treatment groups: medical treatment (MT), percutaneous coronary intervention (PCI), and coronary artery bypass surgery (CABG). Endpoint considered was overall death.Survival was estimated by the Kaplan-Meier method and hazard ratio (HR) using Cox proportional hazard.
Results: Of 611 patients, 112 (18%) had normal renal function, 349 (57%) mild dysfunction, and 150 (25%) moderate dysfunction. Treatment assigned and baseline characteristicswere similar among renal function (RF) groups, except by age,smoking, body mass index, number of diseased vessels, triglycerides, and HDL cholesterollevels. There were significantdifferences among cumulative overall mortality curves among the three renal function groups. Survival rates were 81.3%, 76,2% and 60,7% for normal renal function, mild CKD, and moderate CKD respectively (log-rank=0.001; HR:0.43: 0.26-0.70 for normal RF versus moderate CKD; and HR:0.64; 0.46-0.90 for mild versus moderate CKD). Comparing treatment strategies in RF groups we observed a higher survival in CABG group (81%) compared to those in PCI (75.9%) and MT (71.4%) groups among mild CKD subjects (log-rank:0.015; HR: 0.44; 0.25-0.77 for CABG versus MT; HR: 0.59; 0.33-1.03 for CABG versus PCI)
Conclusions: CAD associated to chronic kidney dysfunction has a worse prognosis, regardless of the therapeutic strategy option. Additionally, our data suggest that CABG is related to higher survival when compared to MT among mild CKD subjects.
Author Disclosures: E.G. Lima: None. W. Hueb: None. C.L. Garzillo: None. D. Favarato: None. A.C. Hueb: None. P.C. Rezende: None. E.E. Silva: None. R.M. Garcia: None. T.L. Scudeler: None. J.A. Ramires: None. R. Kalil Filho: None.
- © 2016 by American Heart Association, Inc.