Chronic kidney disease's impact on revascularization and subsequent major adverse cardiovascular events in patients with chronic coronary syndrome

Shereen Ibrahim Farag; Shaimaa Ahmed Mostafa; Hamza Kabil; Mohamed Reda Elfaramawy

doi:10.1016/j.ihj.2023.11.006

Chronic kidney disease's impact on revascularization and subsequent major adverse cardiovascular events in patients with chronic coronary syndrome

Indian Heart J. 2024 Jan-Feb;76(1):22-26. doi: 10.1016/j.ihj.2023.11.006. Epub 2023 Nov 23.

Authors

Shereen Ibrahim Farag¹, Shaimaa Ahmed Mostafa², Hamza Kabil³, Mohamed Reda Elfaramawy⁴

Affiliations

¹ Benha University, Faculty of Medicine, Cardiology Department, Benha, Egypt. Electronic address: [email protected].
² Benha University, Faculty of Medicine, Cardiology Department, Benha, Egypt.
³ Damiette University, Faculty of Medicine, Cardiology Department, Egypt.
⁴ Al-Ahara Teaching Hospital, Zagazig, El-Sharqia Governorate, Egypt.

Abstract

Objective: To determine the impact of CKD on the completeness of revascularization and major adverse cardiovascular events (MACE) in patients with chronic coronary syndrome (CCS).

Patients and methods: The study enrolled 400 CCS patients who underwent revascularization by PCI. They were separated into two categories according to their eGFR levels: the control group: 200 patients with eGFR ≥60mL/min/1.73m^2, and the CKD Group: 200 patients with eGFR< 60ml/min/1.73m.² Patients were reclassified according to revascularization into complete and incomplete revascularization groups with one-year follow-up to assess the 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), 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. GFR was significantly reduced among patients with incomplete revascularization (51.08 ± 28.15 vs. 65.67 ± 26.62, respectively, P =<0.001). 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 49.50mL/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.

Keywords: Chronic coronary syndrome; Chronic kidney disease; Incomplete revascularization.

MeSH terms

Chronic Disease
Coronary Angiography
Coronary Artery Disease* / complications
Humans
Percutaneous Coronary Intervention* / adverse effects
Renal Insufficiency, Chronic* / complications
Renal Insufficiency, Chronic* / epidemiology
Risk Factors
ST Elevation Myocardial Infarction* / complications
Syndrome
Treatment Outcome