https://orcid.org/0000-0002-0560-3615
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Abstract
Purpose
To investigate the interplay between chronic kidney disease (CKD) and coronary artery disease (CAD) on the incidence of cardiovascular events in patients with suspected chronic coronary syndrome (CCS).
Patients and Methods
Patients with suspected CCS who underwent first-time coronary angiography in Western Denmark between 2003 and 2016 were included in this cohort study. Moreover, an age- and sex-matched general population cohort was established. Patients were stratified according to estimated glomerular filtration rate (eGFR). Presence of CAD was defined as ≥1 obstructive stenosis or non-obstructive diffuse disease. Major adverse cardiovascular events (MACE) were defined as a composite of myocardial infarction, ischemic stroke, and cardiac death.
Results
A total of 42,611 patients were included with a median follow-up of 7.3 years. Patients without and with CAD had MACE rates per 100 person-years that were 0.52 and 1.67 for eGFR ≥90 mL/min/1.73 m2, 0.68 and 2.09 for eGFR 60–89 mL/min/1.73 m2, 1.27 and 3.85 for eGFR 30–59 mL/min/1.73 m2, and 2.27 and 6.92 for eGFR <30 mL/min/1.73 m2. Comparing to eGFR ≥90 mL/min/1.73 m2, the adjusted incidence rate ratios for MACE were 1.29 (1.10–1.51) for eGFR 60–89 mL/min/1.73 m2, 1.86 (1.49–2.33) for eGFR 30–59 mL/min/1.73 m2, and 3.57 (1.92–6.67) for eGFR <30 mL/min/1.73 m2 in patients without CAD, and 1.11 (1.03–1.20), 1.71 (1.55–1.90), and 2.46 (1.96–3.09) in patients with CAD. The inverse relationship between kidney function and risk of MACE was confirmed when comparing patients with and without CAD to matched individuals in the general population.
Conclusion
Absence of CAD is a strong negative predictor of major adverse cardiovascular events in patients with CKD.
Abbreviations
BMI, body mass index; BSA, body surface area; CAD, coronary artery disease; CAG, coronary angiography; CCI, Charlson Comorbidity Index; CCS, chronic coronary syndrome; CKD, chronic kidney disease; CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration; DNPR, Danish National Patient Registry; eGFR, estimated glomerular filtration rate; ESC, European Society of Cardiology; HFrEF, Heart failure with reduced ejection fraction; IRR, Incidence rate ratio; MACE, major adverse cardiovascular events; MI, myocardial infarction; PAD, peripheral artery disease; WDHR, Western Denmark Heart Registry.
Disclosure
KKWO has received a research grant from the Danish Cardiovascular Academy (grant no.: CPD5Y-2022001-HF). CDP has received consultancy fees from Astellas and Astra Zeneca (unrelated to this publication). CDP has also received an institutional research grant from Vifor Pharma (unrelated to this publication). CDP received payment from Boehringer Ingelheim for travel and congress fee for the ERA 2023 Conference in Milan, Italy. NHB is supported by the Novo Nordisk Foundation (grant number NNF21OC0071374) and the Augustinus Foundation (grant number 20-1902) (unrelated to this publication). MM is supported by a grant from the Novo Nordisk Foundation (grant number NNF22OC0074083); has received institutional research grants from Novo Nordisk and Bayer; and has received lecture and/or advisory board fees from AstraZeneca, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, and Novo Nordisk. The authors report no other conflicts of interest in this work.