Dahl Jonathan N, Nissen Louise, Nielsen Marie B, Rasmussen Laust D, Søby Jacob Hartmann, Birn Henrik, Bøttcher Morten, Winther Simon
Department of Cardiology, Gødstrup Hospital, Herning, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Eur J Prev Cardiol. 2025 Apr 18. doi: 10.1093/eurjpc/zwaf218.
Chronic kidney disease (CKD) and coronary artery disease (CAD) share common risk factors, but the association between kidney function (estimated glomerular filtration rate (eGFR) in mL/min/1.73 m²) and major adverse cardiovascular events (MACE) in patients undergoing coronary computed tomography angiography (CCTA) due to suspected CAD has not been established. This study investigated the association between kidney function and MACE in symptomatic patients undergoing CCTA.
A cohort study of consecutive, symptomatic patients undergoing CCTA between 2008 and 2021 (N=70,367). CAD severity was stratified as no CAD, non-obstructive CAD, and obstructive CAD (≥50% diameter stenosis). The primary outcome was MACE (myocardial infarction, ischemic stroke, or cardiovascular death). eGFR was calculated based on plasma creatinine at the time of CCTA.
In total, 41,156 (59%) had eGFR ≥90, 27,011 (38%) had eGFR 60-89, and 2200 (3%) had eGFR 30-59. Median follow-up were 5.1 years, according to eGFR ≥90, 60-89, and 30-59 groups, MACE rates per 1000 person-years in patients with obstructive CAD were 14.2, 15.4, and 25.8, respectively and in patients with non-obstructive CAD the MACE rates were 6.4, 8.0, and 14.4, respectively. Compared to patients with eGFR ≥90, hazard ratios for MACE were 1.09 (95% confidence intervals (CI) 1.00-1.19) and 1.42 (95%CI 1.18-1.69) for patients with eGFR 60-89 and 30-59, respectively.
In patients referred for CCTA due to suspected CAD, reduced kidney function was associated with an increased rate of MACE. Therefore, CKD is a strong independent cardiovascular risk factor, particularly in patients with CAD detected on CCTA.
慢性肾脏病（CKD）和冠状动脉疾病（CAD）有共同的危险因素，但对于因疑似CAD而接受冠状动脉计算机断层扫描血管造影（CCTA）的患者，肾功能（以毫升/分钟/1.73平方米为单位的估计肾小球滤过率（eGFR））与主要不良心血管事件（MACE）之间的关联尚未明确。本研究调查了有症状且接受CCTA的患者中肾功能与MACE之间的关联。
对2008年至2021年间连续有症状且接受CCTA的患者进行队列研究（N = 70367）。CAD严重程度分为无CAD、非阻塞性CAD和阻塞性CAD（直径狭窄≥50%）。主要结局为MACE（心肌梗死、缺血性卒中或心血管死亡）。eGFR根据CCTA时的血浆肌酐计算得出。
总共41156例（59%）患者的eGFR≥90，27011例（38%）患者的eGFR为60 - 89，2200例（3%）患者的eGFR为30 - 59。中位随访时间为5.1年，根据eGFR≥90、60 - 89和30 - 59组，阻塞性CAD患者每1000人年的MACE发生率分别为14.2、15.4和25.8，非阻塞性CAD患者的MACE发生率分别为6.4、8.0和14.4。与eGFR≥90的患者相比，eGFR为60 - 89和30 - 59的患者发生MACE的风险比分别为1.09（95%置信区间（CI）1.00 - 1.19）和1.42（95%CI 1.18 - 1.69）。
在因疑似CAD而接受CCTA检查的患者中，肾功能降低与MACE发生率增加相关。因此，CKD是一个强大的独立心血管危险因素，尤其是在CCTA检查发现有CAD的患者中。
