First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
Med Sci Monit. 2024 May 9;30:e943956. doi: 10.12659/MSM.943956.
BACKGROUND Progression of chronic coronary syndrome (CCS) is influenced by chronic kidney disease (CKD). This 5-year follow-up study aimed to assess 100 patients with 118 intermediate coronary artery lesions evaluated by fractional flow reserve (FFR) and intravascular imaging stratified according to renal function. MATERIAL AND METHODS This prospective study enrolled patients with intermediate coronary stenosis identified by coronary angiogram. Patients with severe renal dysfunction (estimated glomerular filtration rate (eGFR) <45 ml/min/1.73 m²) were excluded from the study. The remaining were divided into 2 groups according to eGFR: 45-60 ml/min/1.73 m² for mild-to-moderate renal dysfunction and >60 ml/min/1.73 m² for no renal dysfunction. We analyzed intermediate-grade stenoses (40-80% as assessed in coronary angiography) with the use of optical coherence tomography (OCT), FFR, and intravascular ultrasound (IVUS). RESULTS Renal dysfunction patients were older (67.7±8.1 vs 63.6±9.7 years, P=0.044). Lesion characteristics, including plaque type and minimal lumen area in OCT, showed no significant differences between the renal dysfunction and no renal dysfunction groups. Thin-cap fibroatheroma, calcific plaques, lipidic plaques, and fibrous plaques had similar prevalence. FFR values and IVUS parameters did not significantly differ between the groups. Over a 5-year follow-up, individuals with mild-to-moderate renal dysfunction had an elevated risk of all-cause mortality and major adverse cardiovascular events in multivariate analyses adjusted for age and sex. CONCLUSIONS Mild-to-moderate renal dysfunction was not associated with significant differences in OCT- and IVUS-derived plaque morphology nor with functional indices characterizing intermediate-grade coronary stenoses. Renal dysfunction was related to a higher risk of all-cause mortality and major adverse cardiovascular events prevalence in 5-year follow-up.
慢性冠状动脉综合征（CCS）的进展受慢性肾脏病（CKD）的影响。本 5 年随访研究旨在评估 100 例通过血流储备分数（FFR）和血管内成像评估的 118 例中间冠状动脉病变患者，根据肾功能进行分层。
这项前瞻性研究纳入了冠状动脉造影显示中间冠状动脉狭窄的患者。严重肾功能障碍（估算肾小球滤过率（eGFR）<45 ml/min/1.73 m²）的患者被排除在研究之外。其余患者根据 eGFR 分为 2 组：45-60 ml/min/1.73 m²为轻度至中度肾功能障碍，>60 ml/min/1.73 m²为无肾功能障碍。我们分析了光学相干断层扫描（OCT）、FFR 和血管内超声（IVUS）评估的中度狭窄（40-80%）。
肾功能障碍患者年龄较大（67.7±8.1 岁 vs 63.6±9.7 岁，P=0.044）。OCT 中的斑块类型和最小管腔面积等病变特征在肾功能障碍组和无肾功能障碍组之间无显著差异。薄帽纤维粥样斑块、钙化斑块、脂质斑块和纤维斑块的患病率相似。FFR 值和 IVUS 参数在两组之间无显著差异。在 5 年随访期间，多变量分析调整年龄和性别后，轻度至中度肾功能障碍患者的全因死亡率和主要不良心血管事件风险升高。
轻度至中度肾功能障碍与 OCT 和 IVUS 衍生的斑块形态无显著差异，也与中间冠状动脉狭窄的功能指标无显著差异。肾功能障碍与 5 年随访期间全因死亡率和主要不良心血管事件发生率升高相关。
