Impact of chronic kidney disease on left main coronary artery disease and prognosis in Japanese patients.
BACKGROUND
Renal insufficiency plays a critical role in the pathogenesis of ischemic heart disease. The aim of the present study was to investigate the prevalence of renal dysfunction and its impact on prognosis in patients with left main coronary artery disease (LMCAD) and stable angina pectoris.


RESULTS
A total of 626 consecutive patients with significant coronary artery stenosis were enrolled. Renal insufficiency was graded using estimated glomerular filtration rate (eGFR) before coronary angiography. Chronic kidney disease (CKD) was defined as eGFR <60 ml·min(-1)·1.73 m(-2) and/or proteinuria. Patients with LMCAD (n=95) had a significantly higher prevalence of CKD than those without LMCAD (P=0.02). Multiple logistic regression analysis showed that CKD was independently associated with LMCAD (adjusted odds ratio, 1.74; 95% confidence interval [CI]: 1.09-2.76, P=0.01). A 1-year follow-up of patients with LMCAD showed that the cumulative incidence of major adverse cardiovascular events among patients with eGFR <30 ml·min(-1)·1.73 m(-2) was higher than that among patients with eGFR ≥60 ml·min(-1)·1.73 m(-2) (P=0.03). The hazard ratio for a cardiovascular event was 9.54 (95% CI: 3.15-28.89, P<0.01) when comparing patients with LMCAD and eGFR <30 ml·min(-1)·1.73 m(-2) vs. patients without LMCAD and eGFR ≥60 ml·min(-1)·1.73 m(-2).


CONCLUSIONS
Renal insufficiency is a risk factor for LMCAD and predicts poor prognosis in Japanese patients.
Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Kazuhiro
K
Dan
Toru
T
Miyoshi
Masayuki
M
Ueeda
Hiroaki
H
Ohtsuka
Satoko
S
Ugawa
Nobuhiko
N
Ohnishi
Atsushi
A
Takaishi
Kazufumi
K
Nakamura
Kengo
K
Kusano
Hiroshi
H
Ito
D000368:Aged; D000369:Aged, 80 and over; D060050:Angina, Stable / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D044466:Asian People; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D023921:Coronary Stenosis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors