Introduction: Cardiovascular morbidity and mortality is associated chronic renal insufficiency in various studies. 1, 2, 3One of the main disadvantages of severe chronic renal insufficiency is that it augments the incidence of cardiovascular disease, particularly of atherosclerotic disease. 4 Milder degrees of renal can also result in adverse cardiovascular consequences. In the present investigation, the relation between renal function and coronary artery disease burden was studied in a cohort of 2687 patients . This prospective study investigated the prevalence of obstructive 3-, 2-, 1-, and 1- to 3-vessel CAD in 398 patients with moderate or severe chronic renal insufficiency versus 2289 patients with mild or no renal insufficiency undergoing coronary angiography for suspected CAD.
Methods:
Setting: The study was carried out in National institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan for a period of 3 years from 2009 till 2011 during which a total of 2688 patients reporting to the angiography department were enrolled. NICVD is a 600 bedded tertiary care cardiac hospital with state of the art cardiac care facilitates. Subjects: Patients were 2145 male and 543 female . Their mean age was 52. 6 ± 10. 1 years. Systemic hypertension was diagnosed if a patient was receiving antihypertensive drug therapy, if systolic blood pressure was ≥140 mm Hg, or if diastolic blood pressure was ≥90 mm Hg. ref Diabetes mellitus was diagnosed if a patient was receiving hypoglycemic drug therapy or if fasting blood sugar was ≥126 mg/dl on ≥2 occasions. ref Patient was termed Smoker if he smoked > 5 cigarettes a day or was an ex-smoker with > 5 pack years. Ref BMI was calculated using height and weight and distributed into 4 categories namely underweight (<18. 5), normal (18. 5-25), overweight (≥25) and obese (≥30). need refThe study had an observational character and required no intervention whatsoever. Patients were enrolled into the study during their initial hospitalization with an acute event or at their first clinic visit. Patients qualified for the study when they had an MI within past 14 days; the diagnosis of unstable angina within past 14 days; an ischemic stroke confirmed by history, physical examination no sooner than 5 d and no later than 30 d after the acute event. Patients with a normal coronary angiogram, and patients with major mechanical complications of AMI were excluded from the study. All patients under study were discharged alive, indicating that patients who died shortly after the ACS were also not included. Patients in this series who were considered to have an indication for surgery, reflecting the fact that patients transferred to the cardiac surgical department in the first few days after the ACS were also not included in the study. Measurement of Kidney FunctionThe abbreviated MDRD equation was used to estimate GFR as per international guidelines. 9, 10eGFR (ml/min per 1. 73 m2)= 175 x [SerumCreatinine(umol/L) x 0. 0113]-1. 154 x Age(years)-0. 203 (x 0. 742 if female) equationIn additional sensitivity analyses, and to reconfirm values of MDRD, CrCl was calculated using the Cockcroft-Gault equation using ideal body weight. 11Severe renal insufficiency (RI)was diagnosed if the GFR was <30 mlmin1. 73 m2. moderate ri was diagnosed if the gfr 30-59 mild orno60-89 m2 and normal 90ml 732 above. angiography: all patients enrolled in study underwentcoronaryangiography. procedure of angiography performed using eitherradialfemoral artery. dominance heart determined as right, left co-dominant. 70% stenosis arterial luminal diameter (in any view) considered a significant lesion. main lesions were counted when reduced by 50%. on basis lesions, diagnosis single vessel disease, two disease three made. statistical analysis: data are presented arithmetic mean standard deviation, divided into tertiles egfr values moderate-severe mild-normal analyzed together groups. chi-square tests used to analyze dichotomous variables. correlations between various parameters under calculated pearson correlation coefficient. pair means continuous variables compared independent student t tests. probability <0. 05 significant.
RESULTS:
A total of 2688 subjects were enrolled. Mean age 52. 6± 10. 1 bmi 27. 1± 5. 0 mean eCcr was 92. 54 ±43. 03Of these, 2145(79. 8%) were male and 543(20. 2%) female. 738 (27. 5%) were smokers; 1608(59. 8%) were hypertensive; 14(0. 4%) had renal impairment and 465(17. 3%) had a family history of hypertension and CAD. 1366(50. 8%) had a history of a previous infarct. Diabetes was present in 714 of 2688 patients (26. 6%) of the total. 52 (1. 9%) were underweight, 924(34. 4%) were normal, 1052 (39. 1%) were overweight and 660 (24. 6%) were obese. 1267(47. 1%) were normal with eGFR above 90ml/min. 1023(38. 1%) were mild, 367(13. 7%) were moderate and 31(1. 2%) were severe with eGFR below 30ml/min. fig1 Of the participants, 2290 had normal or mild eGFR (group1) and 398 participants had Moderate or Severe eGFR (Group 2). Table1 shows the distribution and significance. In general, subjects with lower baseline eGFR were more likely to be older, male, and to have a history of diabetes, hypertension, and CHF. Angiographic studies showed patients with dominance RCA in 1689 (73. 7%), LCA in 296(12. 9%) and co-dominance in 308(13. 4%). Obstructive CAD was present in 2107 out of 2688 (78. 38%) of the patients. Of these, 333 out of 398 (83. 67%) were with moderate or severe decrease in GFR versus 1774 out of 2290 (77. 5%) with mild or no decrease in GFR (p <0. 001). 3-vessel obstructive CAD was present in 168 of 333 (50. 45%) with moderate or severe GFR decrease and in 701 of 1774 patients (39. 5%) with mild or no GFR decrease (p <0. 001). fig 2
Discussion:
In our study, we found that severity of coronary artery disease found in the coronary angiogram, was significantly correlated to the estimated glomerular filtration rate. Estimation of GFR, was divided into tertiles, Severe renal insufficiency (RI)was diagnosed if the GFR was <30 equations
