Highlights
- •Effect of renal function on prognosis in patients with CAD is closely related to cardiac function.
- •Renal insufficiency is related with poorer prognosis in patients with reduced EF vs. preserved EF.
- •Patients with renal failure received less evidence-based preventive medicines.
- •Use of evidence-based preventive medicines was associated with increased survival.
Abstract
Background
Despite strong evidence linking decreased estimated glomerular filtration rate (eGFR)
to worse cardiovascular outcome, the impact of eGFR on mortality in coronary artery
disease (CAD) patients with different left ventricular ejection fraction (EF) is not
well defined.
Methods
A retrospective cohort study. From Jul. 2008 to Jan. 2012, consecutive patients with
CAD of West China Hospital were enrolled and were grouped into 3 eGFR categories:
≥90, 60–90, and <60 mL/min/1.73 m2. Patients with EF ≥ 50% or <50% were defined as preserved EF or reduced EF, respectively. The endpoints were all-cause
mortality and cardiac mortality.
Results
There are 2161 patients according to the inclusion criteria and follow-up requirement.
The mean follow-up time was 30.97 ± 11.70 months. Cumulative survival curves showed that in patients with reduced EF, renal
insufficiency significantly increases all-cause mortality and cardiovascular mortality
in a graded fashion (mortality rate, moderate or severe vs. normal: 29.3% vs. 5.4%, p < 0.001; cardiac mortality rate, moderate or severe vs. normal: 18.2% vs. 4.5%, p = 0.001, respectively). Cox regression analysis showed that in CAD patients with reduced
EF, moderate to severe renal insufficiency increased all-cause mortality by 6.10-fold
(HR 6.10, 95% CI 2.50 to 14.87) and cardiac mortality by 4.10-fold (HR 4.10, 95% CI
1.51 to 11.13). Use of beta-blockers, angiotensin converting enzyme inhibitors (ACEIs)
or angiotensin receptor blockers (ARBs), and statins was associated with decreased
risk of mortality, but the use was lower in renal insufficiency patients, especially
in combination of reduced EF.
Conclusion
This study has found that the effect of renal function on prognosis in patients with
CAD is closely related to cardiac function. In patients with reduced EF, renal insufficiency
accompanies the higher risks of all-cause mortality and cardiovascular mortality.
A higher number of treatments from beta-blocker, ACEIs or ARBs, and statin therapy
were associated with decreased risk of mortality, even in the combination of renal
insufficiency or declining cardiac function.
Keywords
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Article info
Publication history
Published online: January 19, 2016
Accepted:
January 3,
2016
Received in revised form:
December 15,
2015
Received:
September 1,
2015
Identification
Copyright
© 2016 European Federation of Internal Medicine. Published by Elsevier Inc. All rights reserved.
