Mild chronic kidney dysfunction and treatment strategies for stable coronary artery disease.
OBJECTIVE
Our objective was to evaluate the association of chronic kidney dysfunction in patients with multivessel chronic coronary artery disease, preserved left ventricular function, and the possible interaction between received treatment and cardiovascular events.


METHODS
The glomerular filtration rate was determined at baseline on 611 patients who were randomized into three treatment groups: medical treatment, percutaneous coronary intervention, and coronary artery bypass surgery. Incidence of myocardial infarction, angina requiring a new revascularization procedure, and death were analyzed during 5 years in each group.


RESULTS
Of 611 patients, 112 (18%) were classified as having normal renal function, 349 (57%) were classified as having mild dysfunction, and 150 (25%) were classified as having moderate dysfunction. There were significant differences among the cumulative overall mortality curves among the three renal function groups. Death was observed more frequently in the moderate dysfunction group than the other two groups (P < .001). Interestingly, in patients with mild chronic kidney dysfunction, we observed that coronary artery bypass treatment presented a statistically higher percentage of event-free survival and lower percentage of mortality than did percutaneous coronary intervention or medical treatment


CONCLUSIONS
Our results confirm that coronary artery disease accompanied by chronic kidney dysfunction has a worse prognosis, regardless of the therapeutic strategy for coronary artery disease, when renal function is at least mildly impaired. Additionally, our data suggest that the different treatment strategies available for stable coronary artery disease may have differential beneficial effects according to the range of glomerular filtration rate strata.
Lopes
Neuza Helena
NH
Heart Institute, University of São Paulo Medical School, São Paulo, Brazil. mass@incor.usp.br
da Silva Paulitsch
Felipe
F
Pereira
Alexandre
A
Garzillo
Cibele Larossa
CL
Ferreira
João Fernando
JF
Stolf
Noedir
N
Hueb
Whady
W
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002317:Cardiovascular Agents / Q000627:therapeutic use; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D003404:Creatinine / Q000097:blood; D018572:Disease-Free Survival; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D051437:Renal Insufficiency / Q000150:complications / Q000503:physiopathology*
D002317:Cardiovascular Agents; D003404:Creatinine