Steinke Philipp, Akin Ibrahim, Kuhn Lasse, Bertsch Thomas, Weidner Kathrin, Abumayyaleh Mohammad, Dudda Jonas, Rusnak Jonas, Jannesari Mahboubeh, Siegel Fabian, Weiß Christel, Duerschmied Daniel, Behnes Michael, Schupp Tobias
Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, 90419 Nuremberg, Germany.
J Clin Med. 2025 May 27;14(11):3753. doi: 10.3390/jcm14113753.
: In recent decades, shifting demographics and advancements in treating cardiovascular disease have altered the types of patients receiving coronary angiography (CA). However, data investigating the impact of kidney dysfunction stratified by the indication for CA are limited. : Consecutive patients who underwent invasive CA at one institution between 2016 and 2022 were included in this study. Firstly, the prevalence and extent of coronary artery disease (CAD) in patients with different levels of kidney function was assessed. Secondly, the study examined how impaired kidney function affected long-term outcomes-specifically the risk of rehospitalization for heart failure (HF), acute myocardial infarction (AMI), or the need for coronary revascularization-at 36 months of follow-up. : A total of 7624 patients undergoing CA were included with a median estimated glomerular filtration rate (eGFR) of 68.9 mL/min/1.73 m (IQR: 50.8-84.3). In total, 63.7% of patients had an eGFR ≥ 60 mL/min/1.73 m, 29.0% an eGFR of 30-<60 mL/min/1.73 m, and 7.3% an eGFR of <30 mL/min/1.73 m. Compared to patients with an eGFR ≥ 60 mL/min/1.73 m, those with an eGFR 30-<60 mL/min/1.73 m and eGFR < 30 mL/min/1.73 m had a higher prevalence of CAD (66.8% vs. 72.9% and 80.1%, respectively; = 0.001) and three-vessel CAD (25.6% vs. 34.5% and 39.5%, respectively; = 0.001). At 36 months of follow-up, patients with an eGFR 30-<60 mL/min/1.73 m and eGFR < 30 mL/min/1.73 m suffered from significantly higher risk of HF-associated rehospitalization (HR = 1.937, 95% CI: 1.739-2.157, = 0.001 and HR = 3.223, 95% CI: 2.743-3.787, = 0.001, respectively) and AMI compared to patients with an eGFR ≥ 60 mL/min/1.73 m (reference group). The significantly higher risk of HF-related rehospitalization remained after multivariable adjustment. : Both groups with impaired kidney function demonstrated a markedly higher risk of rehospitalization for HF at 36 months-even after multivariate adjustments. Increased risk of HF-related rehospitalization in patients with an eGFR < 30 mL/min/1.73 m was especially evident if they also presented with decompensated HF and LVEF < 35%. In patients with an eGFR 30-<60 mL/min/1.73 m, presenting with angina pectoris and multivessel disease increased the risk of HF-related rehospitalization.
近几十年来，人口结构的变化和心血管疾病治疗的进展改变了接受冠状动脉造影（CA）的患者类型。然而，按CA适应症分层研究肾功能不全影响的数据有限。
本研究纳入了2016年至2022年期间在一家机构接受有创CA的连续患者。首先，评估了不同肾功能水平患者的冠状动脉疾病（CAD）患病率和严重程度。其次，该研究考察了肾功能受损如何影响长期预后，特别是在36个月随访时因心力衰竭（HF）、急性心肌梗死（AMI）再次住院的风险，或冠状动脉血运重建的需求。
共有7624例接受CA的患者被纳入研究，估计肾小球滤过率（eGFR）中位数为68.9 mL/min/1.73 m²（四分位间距：50.8 - 84.3）。总体而言，63.7%的患者eGFR≥60 mL/min/1.73 m²，29.0%的患者eGFR为30 - <60 mL/min/1.73 m²，7.3%的患者eGFR < 30 mL/min/1.73 m²。与eGFR≥60 mL/min/1.73 m²的患者相比，eGFR为30 - <60 mL/min/1.73 m²和eGFR < 30 mL/min/1.73 m²的患者CAD患病率更高（分别为66.8%对72.9%和80.1%；P = 0.001），三支血管CAD患病率也更高（分别为25.6%对34.5%和39.5%；P = 0.001）。在36个月随访时，eGFR为30 - <60 mL/min/1.73 m²和eGFR < 30 mL/min/1.73 m²的患者与eGFR≥60 mL/min/1.73 m²的患者（参照组）相比，因HF相关再次住院的风险显著更高（HR = 1.937，95%置信区间：1.739 - 2.157，P = 0.001；HR = 3.223，95%置信区间：2.743 - 3.787，P = 0.001），AMI风险也更高。多变量调整后，HF相关再次住院的显著更高风险依然存在。
两组肾功能受损患者在36个月时HF再次住院风险均显著更高——即使经过多变量调整。eGFR < 30 mL/min/1.73 m²的患者若同时出现失代偿性HF且左心室射血分数（LVEF）< 35%，HF相关再次住院风险增加尤为明显。在eGFR为30 - <60 mL/min/1.73 m²的患者中，出现心绞痛和多支血管病变会增加HF相关再次住院风险。
