1] Department of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA [2] Heart Institute (InCor), University of São Paulo, São Paulo, Brazil.
1] Department of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA [2] Cardiology Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
Kidney Int. 2015 Jul;88(1):152-9. doi: 10.1038/ki.2014.426. Epub 2015 Jan 28.
It is unknown whether mild chronic kidney disease (CKD) is associated with adverse cardiovascular (CV) prognosis after accounting for coronary artery disease (CAD). Here we evaluated the interplay between CKD and CAD in predicting CV death or myocardial infarction (MI) and all-cause death. We included 1541 consecutive patients in the Partners registry (mean age 55 years, 43% female) over 18 years old with no known prior CAD who underwent coronary computed tomography angiography (CCTA). The results of CCTA were categorized as normal, nonobstructive (under half), or obstructive (half and over). Overall, 653 of the patients had no CAD, 583 had nonobstructive CAD, and 305 had obstructive CAD, while 1299 had eGFR over 60 ml/min per 1.73 m(2) and 242 had an eGFR under this value. The presence and severity of CAD was significantly associated with an increased rate of CV death or MI and all-cause death, even after adjustment for age, gender, symptoms, and risk factors. Similarly, reduced eGFR was significantly associated with CV death or MI and all-cause death after similar adjustment. The addition of reduced GFR to a model which included both clinical variables and CCTA findings resulted in significant improvement in the prediction of CV death or MI and all-cause death. Thus, among individuals referred for CCTA to evaluate CAD, renal dysfunction is associated with an increased rate of CV events, mainly driven by an increase in the rate of noncoronary CV events. In this group of patients, both eGFR and the presence and severity of CAD together improve the prediction of future CV events and death.
目前尚不清楚在考虑到冠状动脉疾病（CAD）后，轻度慢性肾脏病（CKD）是否与不良心血管（CV）预后相关。在这里，我们评估了 CKD 和 CAD 之间的相互作用，以预测 CV 死亡或心肌梗死（MI）和全因死亡。我们纳入了 1541 名年龄在 18 岁及以上、无已知 CAD 病史的 Partners 注册患者，这些患者接受了冠状动脉计算机断层扫描血管造影（CCTA）。CCTA 的结果分为正常、非阻塞性（低于一半）或阻塞性（一半及以上）。总的来说，653 名患者没有 CAD，583 名患者有非阻塞性 CAD，305 名患者有阻塞性 CAD，1299 名患者的 eGFR 超过 60ml/min/1.73m2，242 名患者的 eGFR 低于此值。CAD 的存在和严重程度与 CV 死亡或 MI 和全因死亡的发生率增加显著相关，即使在调整了年龄、性别、症状和危险因素后也是如此。同样，在进行类似调整后，eGFR 降低与 CV 死亡或 MI 和全因死亡显著相关。将 eGFR 降低加入到一个包含临床变量和 CCTA 结果的模型中，可显著改善对 CV 死亡或 MI 和全因死亡的预测。因此，在因评估 CAD 而接受 CCTA 的个体中，肾功能障碍与 CV 事件发生率增加相关，这主要是由于非冠状动脉 CV 事件发生率增加所致。在这群患者中，eGFR 和 CAD 的存在及严重程度均可提高对未来 CV 事件和死亡的预测。
