title: Baseline Characteristics and Prescription Patterns of Standard Drugs in Patients with Angiographically Determined Coronary Artery Disease and Renal Failure (CAD-REF Registry).
abstract: BACKGROUND
  Chronic kidney disease (CKD) is strongly associated with coronary artery disease (CAD). We established a prospective observational nationwide multicenter registry to evaluate current treatment and outcomes in patients with both CKD and angiographically documented CAD.
  
  
  METHODS
  In 32 cardiological centers 3,352 CAD patients with ≥50% stenosis in at least one coronary artery were enrolled and classified according to their estimated glomerular filtration rate and proteinuria into one of five stages of CKD or as a control group.
  
  
  RESULTS
  2,723 (81.2%) consecutively enrolled patients suffered from CKD. Compared to controls, CKD patients had a higher prevalence of diabetes, hypertension, peripheral artery diseases, heart failure, and valvular heart disease (each p<0.001). Myocardial infarctions (p = 0.02), coronary bypass grafting, valve replacements and pacemaker implantations had been recorded more frequently (each p<0.001). With advanced CKD, the number of diseased coronary vessels and the proportion of patients with reduced left ventricular ejection fraction (LVEF) increased significantly (both p<0.001). Percutaneous coronary interventions were performed less frequently (p<0.001) while coronary bypass grafting was recommended more often (p = 0.04) with advanced CKD. With regard to standard drugs in CAD treatment, prescriptions were higher in our registry than in previous reports, but beta-blockers (p = 0.008), and angiotensin-converting-enzyme inhibitors and/or angiotensin-receptor blockers (p<0.001) were given less often in higher CKD stages. In contrast, in the subgroup of patients with moderately to severely reduced LVEF the prescription rates did not differ between CKD stages. In-hospital mortality increased stepwise with each CKD stage (p = 0.02).
  
  
  CONCLUSIONS
  In line with other studies comprising CKD cohorts, patients' morbidity and in-hospital mortality increased with the degree of renal impairment. Although cardiologists' drug prescription rates in CAD-REF were higher than in previous studies, they were still lower especially in advanced CKD stages compared to cohorts treated by nephrologists.
authors: Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors: Holger
authors: H
authors: Reinecke
authors: Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors: Günter
authors: G
authors: Breithardt
authors: Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.|Department of Nephrology, Hypertension, and Rheumatology, University Hospital Muenster, Muenster, Germany.
authors: Christiane
authors: C
authors: Engelbertz
authors: Department of Nephrology and Hypertension, University of Erlangen-Nuernberg, Erlangen, Germany.
authors: Roland E
authors: RE
authors: Schmieder
authors: Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Muenster, Muenster, Germany.
authors: Manfred
authors: M
authors: Fobker
authors: Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
authors: Hans O
authors: HO
authors: Pinnschmidt
authors: Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease, University Hospital Muenster, Muenster, Germany.
authors: Boris
authors: B
authors: Schmitz
authors: Institute of Medical Informatics, University of Muenster, Muenster, Germany.
authors: Philipp
authors: P
authors: Bruland
authors: Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
authors: Karl
authors: K
authors: Wegscheider
authors: Department of Nephrology, Hypertension, and Rheumatology, University Hospital Muenster, Muenster, Germany.
authors: Hermann
authors: H
authors: Pavenstädt
authors: Department of Nephrology, Hypertension, and Rheumatology, University Hospital Muenster, Muenster, Germany.
authors: Eva
authors: E
authors: Brand
mesh_terms: D000368:Aged; D000792:Angiography; D002908:Chronic Disease; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D011379:Prognosis; D012042:Registries; D051437:Renal Insufficiency / Q000150:complications*