Chronic Kidney Disease and Revascularization in Chronic Coronary Syndrome Patients

A new study published in the Indian Heart Journal suggests that chronic kidney disease (CKD) is tied to a higher prevalence of incomplete revascularization in patients with chronic coronary syndrome (CCS).

Study Overview

The study aimed to determine the impact of CKD on the completeness of revascularization and major adverse cardiovascular events (MACE) in CCS patients. It enrolled 400 CCS patients who underwent revascularization by percutaneous coronary intervention (PCI). These patients were divided into two categories based on their estimated glomerular filtration rate (eGFR) levels:

• Control Group: 200 patients with eGFR ≥ 60 mL/min/1.73m²
• CKD Group: 200 patients with eGFR < 60 mL/min/1.73m²

Patients were further classified into complete and incomplete revascularization groups, with a one-year follow-up to assess MACE.

Results

CKD patients were significantly older (65.78 ± 6.41 vs. 56.70 ± 9.20 years, P < 0.001). They had higher syntax scores (P = 0.005), contrast-induced nephropathy (CIN) (P = 0.001), all-cause mortality (P = 0.02), MACE (P = 0.037), and heart failure (P = 0.014). After reclassification according to revascularization, eGFR was significantly reduced among patients with incomplete revascularization (51.08 ± 28.15 vs. 65.67 ± 26.62, respectively, P < 0.001).

Additional Findings

Repeated revascularization (P < 0.001), STEMI (P = 0.003), stent thrombosis (P = 0.015), MACE (P < 0.001), stroke (P < 0.001), and all-cause mortality (P < 0.001) were more prevalent among patients with incomplete revascularization. Multivariate regression analysis revealed eGFR (P = 0.001) and Syntax score (SS) (P < 0.001) as independent predictors of incomplete revascularization. The optimal eGFR cutoff value for predicting partial revascularization is 49.50 mL/min/1.73m², with 58.8% sensitivity and 69.3% specificity.

Conclusion

Chronic kidney disease is associated with a higher syntax score and incomplete revascularization prevalence in CCS patients. Additionally, incomplete revascularization is associated with an increased incidence of major adverse cardiac events. In patients with CCS, CKD predicts partial revascularization and subsequent MACE.

Reference

Shereen Ibrahim Farag, Shaimaa Ahmed Mostafa, Hamza Kabil, Mohamed Reda Elfaramawy. Chronic kidney disease's impact on revascularization and subsequent major adverse cardiovascular events in patients with chronic coronary syndrome, Indian Heart Journal. Volume 76, Issue 1, 2024, Pages 22-26, ISSN 0019-4832, https://doi.org/10.1016/j.ihj.2023.11.006. Read more.